From the Guidelines
Nabicarb 75% in 0.4 NaCl should not be used to treat metabolic acidosis in patients with hypoperfusion-induced lactic acidemia with pH ≥ 7.15, as suggested by the Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock: 2016 1. The use of sodium bicarbonate therapy in this context has been associated with sodium and fluid overload, an increase in lactate and Paco2, and a decrease in serum ionized calcium, but the directness of these variables to outcome is uncertain. The effect of sodium bicarbonate administration on hemodynamics and vasopressor requirements at lower pH, as well as the effect on clinical outcomes at any pH level, is unknown. No studies have examined the effect of bicarbonate administration on outcomes. However, in cases of severe metabolic acidosis (pH < 7.2) where rapid correction is needed, such as in cardiac arrest, diabetic ketoacidosis, or severe renal failure, Nabicarb 75% in 0.4 NaCl may be considered, but with careful monitoring of arterial blood gases, electrolytes, and fluid status to prevent overcorrection and complications 1. The solution contains sodium bicarbonate as the active ingredient, which directly provides bicarbonate ions to buffer hydrogen ions in the blood. The 0.4% NaCl component helps maintain electrolyte balance while correcting the acidosis. Nabicarb is generally preferred over older bicarbonate formulations because it produces less carbon dioxide, making it safer for patients with compromised ventilation. Key considerations in the use of Nabicarb 75% in 0.4 NaCl include:
- Calculating the typical dosage based on the patient's base deficit, weight, and severity of acidosis
- Administering the medication intravenously at a controlled rate
- Monitoring arterial blood gases, electrolytes, and fluid status closely to prevent overcorrection and complications
- Being aware of the potential risks and benefits of sodium bicarbonate therapy in different clinical contexts.
From the FDA Drug Label
Sodium Bicarbonate Injection, USP is indicated in the treatment of metabolic acidosis which may occur in severe renal disease, uncontrolled diabetes, circulatory insufficiency due to shock or severe dehydration, extracorporeal circulation of blood, cardiac arrest and severe primary lactic acidosis Treatment of metabolic acidosis should, if possible, be superimposed on measures designed to control the basic cause of the acidosis Vigorous bicarbonate therapy is required in any form of metabolic acidosis where a rapid increase in plasma total CO2 content is crucial - e. g., cardiac arrest, circulatory insufficiency due to shock or severe dehydration, and in severe primary lactic acidosis or severe diabetic acidosis.
The role of Nabicarb 75% in 0.4 Nacl (which is another term for sodium bicarbonate) in metabolic acidosis is to help treat the condition by increasing the plasma total CO2 content and reversing the acidosis.
- The treatment should be superimposed on measures designed to control the basic cause of the acidosis.
- Vigorous bicarbonate therapy is required in severe cases of metabolic acidosis, such as cardiac arrest or severe dehydration.
- The dosage and administration of sodium bicarbonate should be planned in a stepwise fashion, with the goal of producing a measurable improvement in the abnormal acid-base status of the blood 2, 2.
From the Research
Role of Nabicarb 75% in 0.4 Nacl in Metabolic Acidosis
- Nabicarb 75% in 0.4 Nacl is a formulation of sodium bicarbonate, which is used to treat metabolic acidosis.
- The use of bicarbonate therapy in metabolic acidosis is controversial, and its effectiveness depends on the underlying cause and severity of the condition 3, 4, 5, 6, 7.
- In general, bicarbonate should be given at an arterial blood pH of ≤7.0, and the amount given should be calculated to bring the pH up to 7.2 3.
- The administration of sodium bicarbonate may be beneficial in patients with severe metabolic acidosis, particularly those with accompanying acute kidney injury 5.
- However, the use of bicarbonate therapy in acute metabolic acidosis is not always effective, and its benefits are still debated 4, 6, 7.
- The dosage of sodium bicarbonate should be individualized, and the treatment should be tailored to the specific needs of each patient 3, 4.
- The role of Nabicarb 75% in 0.4 Nacl in metabolic acidosis is to provide a source of bicarbonate to help correct the acid-base imbalance, but its effectiveness depends on the underlying cause and severity of the condition, as well as the individual patient's response to treatment 3, 4, 5, 6, 7.