Sodium Bicarbonate (5% w/w) is a sterile, hypertonic, alkaline solution used primarily for intravenous administration. It acts as a systemic alkalinizing agent and a source of bicarbonate ions, which are vital components of the body's primary buffering system. It is used to correct metabolic acidosis, manage certain drug intoxications, and as an adjunct in advanced cardiac life support (ACLS). In the Indian context, it is a critical drug in emergency medicine, nephrology, and critical care settings.
Adult: Dose is highly individualized based on arterial blood gas (ABG) and serum electrolyte measurements. General guideline: 1-2 mEq/kg (approx. 1.7-3.4 mL/kg of 5% solution) IV over 4-8 hours, not to exceed 50 mEq (approx. 83 mL) in a 10-minute period. For cardiac arrest: 1 mEq/kg IV bolus, may repeat with 0.5 mEq/kg every 10 minutes of continued arrest.
Note: For IV use only. Must be administered as a slow IV infusion, typically over 2-4 hours for correction of acidosis. For emergency use (cardiac arrest), it can be given as a rapid IV bolus. The 5% solution is hypertonic and may cause irritation; ensure secure IV access. Do not administer simultaneously with calcium-containing solutions or catecholamines (e.g., adrenaline, noradrenaline) through the same IV line due to precipitation risk. Always check for extravasation.
Sodium bicarbonate dissociates in blood to provide bicarbonate ions (HCO3-). HCO3- acts as a buffer by combining with excess hydrogen ions (H+) to form carbonic acid (H2CO3), which rapidly dissociates into water and carbon dioxide (CO2). The CO2 is then excreted by the lungs. This reaction shifts the blood pH towards alkalinity, correcting metabolic acidosis. It also increases the plasma bicarbonate buffer capacity, enhances the excretion of certain drugs (like salicylates, barbiturates) by ion-trapping in alkaline urine, and may improve the effectiveness of vasopressors in cardiac arrest by correcting intracellular acidosis.
Pregnancy: Pregnancy Category C (US FDA). No well-controlled studies. Use only if clearly needed, as maternal metabolic acidosis can be harmful to the fetus. Benefits should outweigh risks.
Driving: No effect on driving ability.
| Corticosteroids (e.g., Prednisolone) | Increased risk of sodium retention, edema, and hypokalemia | Major |
| Loop or Thiazide Diuretics (e.g., Furosemide) | Increased risk of hypokalemia and hypochloremic alkalosis | Major |
| Lithium | Increased renal excretion of lithium, decreasing its serum levels and efficacy | Major |
| Aspirin (Salicylates) | Increased renal excretion of salicylates in alkaline urine; used therapeutically in overdose | Moderate |
| Methotrexate | Increased renal excretion, may reduce efficacy/toxicity | Moderate |
| Quinidine, Flecainide | Alkalinization of urine decreases renal excretion, increasing plasma levels and risk of toxicity | Moderate |
| Calcium-containing IV solutions (e.g., Calcium Gluconate) | Risk of precipitation when mixed | Major (Physical Incompatibility) |
| Catecholamines (e.g., Adrenaline, Noradrenaline) | Inactivation/degradation when mixed | Major (Physical Incompatibility) |
Same composition (Sodium Bicarbonate (5% w/w)), different brands: