What is the recommended dosage and dilution for sodium bicarbonate (NaHCO3) injection?

Sodium Bicarbonate Injection Dosage and Dilution Guidelines

For sodium bicarbonate injection, the standard dilution is 8.4% solution (1 mEq/mL) for adults, with dosing of 1-2 mEq/kg administered intravenously based on the severity of acidosis and clinical situation. 1

Standard Dosing Guidelines

• For cardiac arrest, a rapid intravenous dose of 44.6 to 100 mEq (one to two 50 mL vials) may be given initially and continued at 44.6 to 50 mEq every 5-10 minutes if necessary, guided by arterial pH and blood gas monitoring 1
• For metabolic acidosis in adults, the recommended dose is approximately 2-5 mEq/kg of body weight administered over a 4-8 hour period, depending on the severity of acidosis 1
• For children, the standard dose is 1-2 mEq/kg IV administered slowly 2
• For newborn infants, only use the 0.5 mEq/mL concentration, with dilution of available stock solutions as necessary 2

Dilution and Administration

• Sodium bicarbonate is available as an 8.4% solution (1 mEq/mL) for adults 1
• For less urgent forms of metabolic acidosis, sodium bicarbonate may be added to other intravenous fluids 1
• For sodium channel blocker toxicity, a bolus of 50-150 mEq followed by an infusion of 150 mEq/L solution at 1-3 mL/kg/h is recommended 2
• For contrast-induced nephropathy prevention, sodium bicarbonate (154 mEq/L in dextrose and water) can be administered at 3 mL/kg for 1 hour before contrast medium, followed by 1 mL/kg/h for 6 hours after the procedure 3

Stability Information

• Sodium bicarbonate solutions of 50,100, and 150 mEq in sterile water for injection or 5% dextrose injection remain stable for up to seven days when refrigerated (2-4°C) 4
• At room temperature (21-24°C), 50 mEq solutions are stable for up to 48 hours, while 100 and 150 mEq solutions are stable for up to 30 hours 4

Monitoring and Precautions

• Bicarbonate therapy should always be planned in a stepwise fashion since the degree of response from a given dose is not precisely predictable 1
• It is generally unwise to attempt full correction of a low total CO2 content during the first 24 hours of therapy, as this may result in unrecognized alkalosis due to delayed ventilatory adjustment 1
• Monitor serum bicarbonate levels every 2-4 hours during active bicarbonate infusion therapy 5
• Continue sodium bicarbonate drip until serum bicarbonate reaches ≥22 mmol/L in patients with metabolic acidosis 5

Important Cautions

• Bicarbonate solutions are hypertonic and may produce an undesirable rise in plasma sodium concentration while correcting metabolic acidosis 1
• Sodium bicarbonate administration can cause a leftward shift in the oxyhemoglobin dissociation curve, potentially impairing tissue oxygenation 6
• Do not mix sodium bicarbonate with vasoactive amines or calcium 2
• Parenteral drug products should be inspected visually for particulate matter and discoloration prior to administration 1

Special Considerations

• In cardiac arrest, the risks from acidosis generally exceed those of hypernatremia 1
• For severe acidosis (pH <7.0), continue infusion until pH rises above 7.0, then reassess the need for further therapy 5
• Achievement of total CO2 content of about 20 mEq/liter at the end of the first day of therapy will usually be associated with a normal blood pH 1