Sodium Bicarbonate

How it works

Bicarbonate ions buffer excess hydrogen ions, raising blood pH, while also promoting an intracellular shift of potassium.

Prescribing in practice

• Rapid or excessive administration can cause metabolic alkalosis, hypokalaemia, hypernatraemia, fluid overload and a fall in ionised calcium, so it should be reserved for clearly indicated severe acidosis.
• It is hypertonic and irritant, and extravasation can cause tissue damage; large-vein or central administration is preferred for concentrated solutions.
• It is incompatible with calcium-containing solutions and many other drugs, which may precipitate in the line.

Monitoring

Monitor arterial blood gases, serum electrolytes including potassium and sodium, and acid-base status during therapy.

Counselling the patient

• Inform the team that the infusion site should be checked for extravasation.
• Advise that potassium and pH are rechecked to guide further dosing.

Evidence & guidelines

Its role is supported by acute care and resuscitation guidance, which generally restricts use to severe acidosis and specific indications rather than routine correction.