What is the dose for a sodium bicarbonate infusion?

From the Guidelines

Sodium Bicarbonate Infusion Dose

The recommended dose of sodium bicarbonate infusion is 50-150 mEq for adults, with a preparation of 150 mEq/L solution, infused at a rate of 1-3 mL/kg/h 1.

• For pediatric patients, the dose is 1-3 mEq/kg.
• The infusion should be prepared with caution, as different sodium bicarbonate solutions are typically used for adults (1 mEq/mL) and children (0.5 mEq/mL), both of which are hypertonic.
• It is crucial to monitor for potential side effects such as hypernatremia, alkalemia, hypokalemia, and hypochloremia during the infusion 1.
• The dose and administration rate should be titrated to achieve the desired clinical effect, taking into consideration the patient's specific condition, such as sodium channel blocker overdose or cocaine toxicity.
• While another study suggests that routine use of sodium bicarbonate is not recommended for patients in cardiac arrest, it may be beneficial in special situations like preexisting metabolic acidosis, hyperkalemia, or tricyclic antidepressant overdose, with an initial dose of 1 mEq/kg 1.

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 for a sodium bicarbonate infusion is:

• Initial dose in cardiac arrest: 1-2 50 mL vials (44.6 to 100 mEq) given rapidly intravenously
• Continuation dose in cardiac arrest: 50 mL (44.6 to 50 mEq) every 5 to 10 minutes if necessary
• Dose in less urgent metabolic acidosis: 2 to 5 mEq/kg of body weight over a period of 4 to 8 hours 2

From the Research

Dose for Sodium Bicarbonate Infusion

The provided studies do not directly address the dose for a sodium bicarbonate infusion. However, some studies mention the use of sodium bicarbonate in specific contexts:

• In the study 3, it is mentioned that isotonic solutions should be preferred instead of hypertonic bicarbonate, but no specific dose is provided.
• The study 4 discusses the use of oral sodium bicarbonate, starting at 500 mg three times daily, increasing to 1 g three times daily if necessary, but this is not relevant to intravenous infusion.
• The other studies 5, 6, 7 do not provide information on the dose for sodium bicarbonate infusion.

Key Considerations

When administering sodium bicarbonate, the following points should be considered:

• The need for a risk-benefit assessment, considering potential complications such as hypernatremia, hypokalemia, and rebound alkalosis 3.
• The importance of monitoring patients with serial evaluation of arterial blood gases, plasma electrolytes, and ionized calcium 3.
• The potential benefits and limitations of sodium bicarbonate therapy in specific patient populations, such as those with severe metabolic acidosis or chronic kidney disease 3, 5, 4.

Administration and Monitoring

Some key points to consider when administering sodium bicarbonate include:

• The use of isotonic solutions instead of hypertonic bicarbonate 3.
• The need to prevent hypernatremia and provide calcium for hypocalcemia to improve cardiovascular function 3.
• The importance of establishing a respiratory response similar to the physiological response to extract excess CO2 and avoid intracellular acidosis in mechanically ventilated patients 3.