Alkalising Agent / Electrolyte
Pregnancy: Use with caution — sodium load; short-term use acceptable in life-threatening acidosis
Sodium Bicarbonate
Brand names: Minijet Sodium Bicarbonate, Sodium Bicarbonate 8.4%
Adult dose
Dose: Severe metabolic acidosis: 1 mmol/kg IV (1 mL/kg of 8.4%); TCA overdose: 1–2 mmol/kg IV bolus
Route: IV
Frequency: As per ABG-guided titration
Max: Titrated to pH target; avoid pH >7.5
8.4% = 1 mmol/mL. Used in severe metabolic acidosis (pH <7.1), hyperkalaemia, TCA overdose, cocaine toxicity, and as antidote for Na-channel blocking drugs. NOT routinely recommended in cardiac arrest (CO2 production worsens intracellular acidosis unless adequate ventilation).
Paediatric dose
Dose: 1 mmol/kg
Route: IV
Frequency: Per ABG guidance
Max: Titrated to response
Neonates/infants: use 4.2% (0.5 mmol/mL) — hyperosmolality risk with 8.4%. Dose: 1–2 mmol/kg slowly IV.
Dose adjustments
Renal
Use with caution — sodium and fluid load. Monitor electrolytes.
Hepatic
No specific adjustment required.
Paediatric weight-based calculator
Neonates/infants: use 4.2% (0.5 mmol/mL) — hyperosmolality risk with 8.4%. Dose: 1–2 mmol/kg slowly IV.
Clinical pearls
- TCA overdose: sodium bicarbonate is the antidote — reverses Na-channel blockade (narrow QRS) and increases protein binding of TCA; target pH 7.45–7.55
- Hyperkalaemia: 50 mL of 8.4% IV shifts K+ intracellularly within 15 minutes (temporising — does not remove K+ from body)
- ALS 2021: sodium bicarbonate is not routinely recommended in cardiac arrest — only for specific reversible causes (hyperkalaemia, TCA OD, severe pre-existing acidosis)
Contraindications
- Metabolic alkalosis
- Hypochloraemic alkalosis
- Hypocalcaemia (alkalosis worsens tetany)
- Adequate ventilation must be present (CO2 generated)
Side effects
- Hypernatraemia
- Hyperosmolality
- Metabolic alkalosis (overshoot)
- Hypokalaemia (K+ shifts intracellularly)
- Paradoxical intracellular acidosis (CO2 diffuses into cells)
- Tissue necrosis on extravasation (highly alkaline)
Interactions
- Calcium salts (precipitates if mixed — never co-administer in same line)
- Adrenaline (alkaline solution inactivates catecholamines — give separately)
Monitoring
- ABG (pH, bicarbonate, pCO2)
- Serum sodium and osmolality
- Serum potassium
- ECG (TCA overdose — QRS duration)
Reference: BNFc; BNF 90; Resuscitation Council UK ALS 2021; TOXBASE; BNFc. Verify against your local formulary and the latest BNF before prescribing.
Related
Curated clinical cross-links plus same-class fallbacks.
Calculators