Does an 8.4% solution of sodium bicarbonate contain 150 meq of sodium bicarbonate?

Sodium Bicarbonate 8.4% Concentration

No, an 8.4% solution of sodium bicarbonate contains 1 mEq/mL (or 1000 mEq/L), not 150 mEq per standard vial. 1

Standard Concentration and Volume

• The FDA-approved 8.4% sodium bicarbonate injection contains 1 mEq/mL, which means a standard 50 mL vial contains 50 mEq total 1
• The American Heart Association consistently references 8.4% solution as "1 mEq/mL" when describing dosing protocols 2
• For adult toxicology emergencies, guidelines recommend "1 mL/kg of sodium bicarbonate solution (8.4%, 1 mEq/mL)" 2

Clinical Dosing Context

• When guidelines recommend "50-100 mEq" for adults with severe metabolic acidosis, this translates to 50-100 mL of 8.4% solution 2
• A typical 70 kg adult receiving 1-2 mEq/kg would receive 70-140 mEq, which equals 70-140 mL of 8.4% solution 2
• The American Heart Association recommends initial bolus doses of 50-150 mEq for sodium channel blocker toxicity, followed by continuous infusion of 150 mEq/L solution 3

Preparation of 150 mEq Solutions

• When a 150 mEq/L infusion is recommended (as in sodium channel blocker overdose management), this requires diluting sodium bicarbonate in a larger volume of fluid 3
• The American Heart Association suggests continuing with "an infusion of 150 mEq NaHCO3/L solution" at 1-3 mL/kg/h after initial bolus 3
• This 150 mEq/L concentration is achieved by adding 150 mEq (150 mL of 8.4% solution) to make a total volume of 1000 mL 3

Common Pitfall to Avoid

• Do not confuse the concentration per mL (1 mEq/mL) with the total amount in a vial (50 mEq per 50 mL vial) or with diluted infusion concentrations (150 mEq/L) 2, 1
• The 8.4% solution is hypertonic with an osmolality of approximately 2000 mOsm/L, which is why dilution is often required for safety 3