Sodium bicarbonate with sodium chloride

How it works

Bicarbonate buffers excess hydrogen ions to raise blood pH, while sodium chloride contributes to sodium and extracellular volume replacement.

Prescribing in practice

• The combined sodium from both components gives a substantial sodium load, so it should be used cautiously in cardiac failure, hypertension and oedematous states and avoided in metabolic or respiratory alkalosis.
• Over-administration can cause metabolic alkalosis, hypokalaemia, hypocalcaemia and hypernatraemia, so dosing should be guided by acid-base and electrolyte results.
• It should not be co-administered through the same line as calcium-containing solutions because of the risk of precipitation.

Monitoring

Monitor arterial blood gases, serum electrolytes including potassium and calcium, and fluid balance during administration.

Counselling the patient

• Explain that this drip helps correct acid levels in the blood and replaces salt and fluid.
• Report swelling, breathlessness or discomfort at the infusion site.

Evidence & guidelines

Sodium bicarbonate therapy is reserved for specific indications such as significant metabolic acidosis, with electrolyte and acid-base monitoring guiding its use.