Alkalinising IV solution
Sodium bicarbonate with sodium chloride
Adult dose
Dose: 1.26% NaHCO3 (isotonic) — variable rate per indication; e.g. 1L over 4h for metabolic acidosis
Route: IV
Frequency: per indication
Clinical pearls
- Metabolic acidosis (severe), salicylate / TCA poisoning, urinary alkalinisation
- Monitor pH/electrolytes closely
Contraindications
- Severe metabolic alkalosis
- Hypocalcaemia (uncorrected)
- Severe respiratory failure (CO2 generation)
Side effects
- Metabolic alkalosis
- Hypernatraemia
- Hypokalaemia
- Hypocalcaemia (ionised drop)
- Volume overload
Interactions
- Calcium-containing solutions (precipitate)
Monitoring
- ABG
- Electrolytes
- Volume status
Reference: BNF; UK guidelines; TOXBASE; https://bnf.nice.org.uk/drugs/sodium-bicarbonate-with-sodium-chloride/. Verify against your local formulary and the latest BNF before prescribing.
Related
Curated clinical cross-links plus same-class fallbacks.
Calculators
Pathways
- New-Onset Atrial Fibrillation · ESC 2020 AF Guidelines; NICE NG196
- Hypertensive Emergency · ESC/ESH 2018 Hypertension Guidelines; NICE NG136
- Bradycardia Management · Resuscitation Council UK ABCDE; ESC 2021 Pacing Guidelines
- Ventricular Tachycardia / Fibrillation · Resuscitation Council UK ACLS; ESC 2022 Ventricular Arrhythmia Guidelines
- Syncope Assessment · ESC 2018 Syncope Guidelines; NICE NG109
- Acute Chest Pain · NICE CG95; ESC 2023 ACS Guidelines