From the Guidelines
The recommended dose for a sodium bicarbonate infusion is 150 mEq of sodium bicarbonate in 1 liter of D5W, with the goal of maintaining a serum pH between 7.35-7.45, as supported by the most recent guidelines from the American Heart Association 1. When administering sodium bicarbonate, it is crucial to monitor the patient's arterial blood gases and serum electrolytes to adjust the dosing accordingly.
- The infusion rate can be adjusted based on the patient's fluid status and response to treatment.
- For urgent treatment of severe metabolic acidosis, a bolus dose of 1-2 mEq/kg can be administered over 10-15 minutes, followed by the continuous infusion.
- The concentration can be adjusted based on the patient's fluid status, with more concentrated solutions (up to 3 ampules or 150 mEq in 500 mL) for fluid-restricted patients.
- Experts recommend avoiding extremes of hypernatremia (serum sodium not to exceed 150–155 mEq/L) and alkalemia (serum pH not to exceed 7.50–7.55) to avoid iatrogenic harm, as noted in the 2023 American Heart Association guidelines 1.
- Patients should be monitored and treated for hypokalemia during alkalemia therapy, as hypertonic sodium bicarbonate therapy can cause hypokalemia. The underlying cause of acidosis should always be identified and treated concurrently with bicarbonate therapy, and caution is needed as rapid administration can cause paradoxical CNS acidosis, hypokalemia, hypocalcemia, and fluid overload.
From the FDA Drug Label
DOSAGE AND ADMINISTRATION Sodium Bicarbonate Injection, USP is administered by the intravenous route. In cardiac arrest, a rapid intravenous dose of one to two 50 mL vials (44.6 to 100 mEq) may be given initially and continued at a rate of 50 mL (44. 6 to 50 mEq) every 5 to 10 minutes if necessary (as indicated by arterial pH and blood gas monitoring) to reverse the acidosis. In less urgent forms of metabolic acidosis, Sodium Bicarbonate Injection, USP may be added to other intravenous fluids The amount of bicarbonate to be given to older children and adults over a four-to-eight-hour period is approximately 2 to 5 mEq/kg of body weight - depending upon the severity of the acidosis as judged by the lowering of total CO2 content, blood pH and clinical condition of the patient
The dose of sodium bicarbonate (NaHCO3) infusion is:
- Initial dose in cardiac arrest: 1-2 vials of 50 mL (44.6-100 mEq)
- Continuous dose in cardiac arrest: 50 mL (44.6-50 mEq) every 5-10 minutes
- Dose in less urgent metabolic acidosis: 2-5 mEq/kg body weight over 4-8 hours 2
From the Research
Dose of Sodium Bicarbonate Infusion
The dose of sodium bicarbonate (NaHCO3) infusion can vary depending on the specific medical condition being treated.
- In a study on severe metabolic acidosis during prolonged cardiopulmonary resuscitation, the dose of sodium bicarbonate was not specified 3.
- A study on intravenous sodium bicarbonate therapy in severely acidotic diabetic ketoacidosis reported a median dose of 100 mEq (100-150) of intravenous bicarbonate 4.
- Another study compared the efficacy of sodium bicarbonate and THAM in ICU patients with mild metabolic acidosis, where sodium bicarbonate was administered over a 1-hour period, but the exact dose was not provided 5.
- A study on the combined effect of bicarbonate and insulin with glucose in acute therapy of hyperkalemia in end-stage renal disease patients used an infusion of 8.4% solution of sodium bicarbonate at 2 mEq/min for 60 min 6.
- A formula for calculating bicarbonate dose in metabolic acidosis was devised to elevate the pH to the region about 7.30, but the exact formula was not provided in the text 7.