Sodium Bicarbonate

Note: 1 mEq NaHCO3 is equivalent to 84 mg; each g of NaHCO3 provides ~12 mEq each of sodium and bicarbonate ions. Each oral tablet (650 mg) contains 7.7 mEq each of sodium and bicarbonate ions. Cardiac arrest (ACLS 2010): IV: Initial: 1 mEq/kg/dose; repeat doses should be guided by arterial blood gases Routine use of NaHCO 3 is not recommended. May be considered in the setting of prolonged cardiac arrest only after adequate alveolar ventilation has been established and effective cardiac compressions. Note: In some cardiac arrest situations (eg, metabolic acidosis, hyperkalemia, or tricyclic antidepressant overdose), sodium bicarbonate may be beneficial. Metabolic acidosis in patients with chronic kidney disease: Oral (off-label): Note: KDIGO guidelines suggest oral replacement when plasma HCO3- concentrations are Initial: 15.4 to 23.1 mEq/day in divided doses (eg, 650 mg tablet 2 to 3 times daily); titrate to normal serum bicarbonate concentrations (eg, 23 to 29 mEq/L) or up to 5850 mg/day; baking soda may be used as an alternative in patients who cannot take tablets (Chen 2014; KDIGO 2013; Kovesdy 2009; Raphael 2016). Avoid exceeding serum bicarbonate concentrations >32 mEq/L since this has been associated with increased mortality in patients with CKD (Navaneethan 2011). Metabolic acidosis: IV: Dosage should be based on the following formula if blood gases and pH measurements are available: HCO3-(mEq) = 0.5 x weight (kg) x [24 - serum HCO3-(mEq/L)] or HCO3-(mEq) = 0.5 x weight (kg) x [desired increase in serum HCO3-(mEq/L)] Administer 1/2 dose initially, then remaining 1/2 dose over the next 24 hours; monitor pH, serum HCO3-, and clinical status. Note: These equations provide an estimated replacement dose. The underlying cause and degree of acidosis may result in the need for larger or smaller replacement doses. In most cases, the initial goal of therapy is to target a pH of ~7.2 and a plasma bicarbonate level of ~10 mEq/L to prevent overalkalinization. According to the ARDSNet protocol, if pH remains 3 (Brower 2004). If acid-base status is not available: 2 to 5 mEq/kg IV infusion over 4 to 8 hours; subsequent doses should be based on patient's acid-base status. Hyperkalemia (ACLS 2010): IV: 50 mEq over 5 minutes (as appropriate, consider methods of enhancing potassium removal/excretion) Renal tubular acidosis: Oral: Distal: 0.5 to 2 mEq/kg/day in 4 to 5 divided doses Proximal: Initial: 5 to 10 mEq/kg/day; maintenance: Increase as required to maintain serum bicarbonate in the normal range Urine alkalinization: Oral: Initial: 48 mEq (4 g), then 12 to 24 mEq (1 to 2 g) every 4 hours; dose should be titrated to desired urinary pH; doses up to 16 g/day (200 mEq) in patients 60 years. Administration of 48 mEq (4 g) every 8 hours for a total daily dose of 144 mEq (12 g) has also been shown to achieve a urinary pH of at least 7 after a period of 10 hours in one study of healthy volunteers (Cohen 2013). Note: Intravenous administration is preferred in s