Sodium Bicarbonate

Registered South African indications: 

• Metabolic acidosis
• Prevention of dilutional acidosis
• Haemodialysis in acute or chronic renal failure
• Electrolyte disturbances
• Significant loss of bicarbonate
• Fluid overload
• Acute poisoning from weakly acidic drugs
• Removal of metabolites
• Intoxication

Contraindications

• Hypersensitivity to the active ingredient or to any of its excipients
• End stage renal impairment (eGFR ≤19ml/min/1.73m² (or with oliguria))
• Conditions where sodium intake is restricted
  - Renal failure
  - Hypertension
  - Oedema
  - Congestive heart failure
• Patients with hypoventilation
• Metabolic or respiratory alkalosis
• History of urinary calculi
• Potassium depletion
• Chloride depletion
• Hypocalcaemia
• Hypernatraemia

Cautions

• Pregnancy
• Breastfeeding
• Severe renal impairment (eGFR 19-29ml/min/1.73m²)
• Hepatic impairment
• Use of scalp veins for administration
• Inadequate minute ventilation
• Long-term therapy
• Hypoperfusion-induced lactic acidaemia associated with sepsis

Forms avail. in SA and covered in this monograph: inj

Metabolic acidosis 
- Associated with cardiac arrest in patients with pre-existing metabolic acidosis
Cardiac arrest
- Associated with hyperkalaemia with pre-existing metabolic acidosis
Life-threatening hyperkalaemia
- With pre-existing metabolic acidosis
Tricyclic antidepressant overdose 

• IV: Dependent on acid-base imbalance; Usual dose: 1mmol/kg; THEN 0.5mmol/kg every 10min

Prevention of dilutional acidosis during large volume replacement therapy with fluids that do not contain sodium bicarbonate or bicarbonate precursors 
Conditions resulting in significant loss of bicarbonate 
Acute poisoning from weakly acidic drugs (forced alkaline diuresis)

• IV: Dependent on acid-base imbalance; Max dose: 300mmol

Haemodialysis in acute or chronic renal failure
Electrolyte disturbances
Fluid overload
Intoxication with poisons or drugs 
Removal of metabolites

• IV: Frequency of treatment, formulation and length of dialysis should depend on the individual patient

Sodium bicarbonate 4.2%: Administered IV, but may be administered SC if IV route is not possible

1mmol is equiv. to 1ml of the 8.4% solution or 2ml of the 4.2% solution

Paed. forms avail. in SA and covered in this monograph: Inj

Metabolic acidosis 
- Associated with cardiac arrest in patients with pre-existing metabolic acidosis
Cardiac arrest 
- Associated with hyperkalaemia with pre-existing metabolic acidosis
Life threatening hyperkalemia
- With pre-existing metabolic acidosis
Tricyclic antidepressant overdose 
Burns 
Acute fluid resuscitation 

• IV: Dependent on acid-base imbalance; Usual dose: 1mmol/kg by slow injection

In premature infants and neonates, the 8.4% solution should be diluted 1:1 with 5% dextrose

No benefits have been demonstrated from the routine use of sodium bicarbonate in resuscitation of neonates. In neonates, sodium bicarbonate is recommended in resuscitation only in cases of prolonged cardiac arrest, irresponsive to other therapy, after establishment of adequate ventilation and circulation

Pregnancy

• Caution
• Safe use in pregnancy has not been established. The use of any agent in pregnant women requires that the expected benefit be carefully weighed against the possible risk to the mother and child

Breastfeeding

• Caution
• The use of any agent in breastfeeding women requires that the expected benefit be carefully weighed against the possible risk to the mother and child
• Patients requiring intravenous sodium bicarbonate are unlikely to be fit enough to breastfeed

Renal Impairment

• eGFR ≥30ml/min/1.73m²: No dose adjustment recommended
• eGFR 19-29ml/min/1.73m²: Caution; no dose adjustment recommended
  Without oliguria: Place IV fluids infusion rate to slow. Closely monitor renal output (24 hour urine collection)
• eGFR ≤19ml/min/1.73m² (or with oliguria): Contraindicated

Hepatic Impairment

• Caution; no dose adjustment recommended

Elderly

• No dose adjustment recommended

Porphyria Information

• Not yet classified (NC)

Drugs in Sport

• Non-regulated product
• Non-regulated products are not subjected to rigorous controls to verify its efficacy, safety, nor that the ingredients, dosages and claims listed on the label are indeed accurate, therefore authorities caution athletes against the risk of using these products

Central Nervous System Disorders 

• Intracranial haemorrhage (neonates)
• Hyperirritability
• Tetany

Cardiovascular Disorders 

• Deterioration of haemodynamic status associated with volume overload

Endocrine and Metabolic System Disorders 

• Alkalosis
• Hypokalaemia
• Hypernatremia
• Hyperosmolarity
• Hypocalcemia
• Hypoglycemia
• Paradoxical intracellular acidosis

Others 

• Extravasation
• Tissue necrosis (incorrect administration)

• Corticosteroids
• Corticotrophin
• Potassium depleting diuretics
• Bumetanide
• Ethacrynic acid
• Furosemide
• Thiazides
• Potassium supplements
• Tetracyclines 
• Doxycycline 
• Acetylsalicylic acid
• Chlorpropamide
• Lithium
• Methenamine
• Quinidine
• Amphetamines
• Ephedrine
• Pseudoephedrine
• Memantine
• Flecainide
• Mecamylamine

• Acid-base balance
• Electrolytes (including calcium)

Specific cases may require

• Urinary pH
• Arterial blood gases

Injection - EML (Hospital)

Other formulations - EML Unknown 

Sodium bicarbonate therapy increases plasma bicarbonate, buffers excess hydrogen ion concentration, raises blood pH and reverses clinical manifestations of metabolic acidosis. 

Solution 84g 

• Sabax Liq Bicarb Concentrate 8.4% (Adcock Ingram) originator

Injection 8.4g/ 1000ml 

• Sabax Sod Bicarb 4.2% (Adcock Ingram) originator

Injection 42g/ 1000ml;

• Sabax Sod Bicarb 4.2% (Adcock Ingram) originator

Solution 84g/ 1000ml

• Alkaline Bicarbonate Haemodialysis Concentrate (B Braun Medical) originator

DIA 650g

• Solcart B Haemodialysis (B Braun Medical) originator

Injection 4.25g/ 50ml

• Intramed Sodium Bicarbonate 8.5% (Bodene)

Injection 2g/ 50ml

• Intramed Sodium Bicarbonate 4% (Bodene)
• Sodium Bicarbonate Fresenius 4% (Fresenius Kabi)