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Sodium Bicarbonate (Monograph)

Brand names: Baking Soda, Neut, Soda Mint
Drug class: Alkalinizing Agents
CAS number: 144-55-8

Medically reviewed by Drugs.com on Feb 22, 2024. Written by ASHP.

Warning

A standardized concentration for this drug has been established through Standardize 4 Safety (S4S), a national patient safety initiative to reduce medication errors, especially during transitions of care. The drug is included in a standard concentration list which may apply to an IV or oral compounded liquid formulation. For additional information, see the ASHP website [Web].

Introduction

Alkalinizing agent.

Uses for Sodium Bicarbonate

Acidosis

Treatment of metabolic acidosis associated with many conditions including severe renal disease (e.g., renal tubular acidosis), uncontrolled diabetes (ketoacidosis), extracorporeal circulation of the blood, cardiac arrest, circulatory insufficiency caused by shock or severe dehydration, ureterosigmoidostomy, lactic acidosis, alcoholic ketoacidosis, use of carbonic anhydrase inhibitors, and ammonium chloride administration.

Generally considered the alkalinizing agent of choice for oral or parenteral therapy.

Diabetic Ketoacidosis

Specific role of sodium bicarbonate therapy in the treatment of diabetic ketoacidosis not established. Administration is generally reserved for the treatment of severe acidosis (e.g., arterial pH less than 7–7.15 or serum bicarbonate concentration of 8 mEq/L or less) because of the potential risks of sodium bicarbonate therapy in the treatment of this disorder.

Advanced Cardiovascular Life Support

ACLS guidelines state that IV sodium bicarbonate is not recommended for routine use during cardiac arrest; limited data to support such use and potentially associated with detrimental effects. However, may be useful in some resuscitation situations (e.g., preexisting metabolic acidosis, hyperkalemia, tricyclic antidepressant overdosage).

Alkalinization of Urine

Treatment of hemolytic reactions requiring alkalinization of the urine to diminish the nephrotoxic effects of blood pigments; also to increase urinary pH in order to increase the solubility of certain weak acids (e.g., cystine, sulfonamides, uric acid).

Sodium Bicarbonate Dosage and Administration

General

Administration

Administer orally, by direct IV injection or infusion.

May be administered by intraosseous (IO) injection [off-label] in the setting of pediatric advanced life support (PALS).

Also has been administered by sub-Q injection if diluted to isotonicity (1.5% sodium bicarbonate solution); avoid extravasation of hypertonic sodium bicarbonate injections.

Oral Administration

Administered orally in the treatment of mild to moderately severe acidosis, in conditions (e.g., chronic renal failure) requiring prolonged therapy with an alkalinizing agent, and in conditions in which IV administration of the drug is not necessary (e.g., alkalinization of the urine).

IV Administration

For solution and drug compatibility information, see Compatibility under Stability.

Rate of Administration

Neonates and children <2 years of age: Administer hypertonic sodium bicarbonate injections by slow IV infusion of a 4.2% solution (up to 8 mEq/kg daily).

Dosage

Each 84 mg or 1 g of sodium bicarbonate contains 1 or about 12 mEq, respectively, each of sodium and bicarbonate ions.

Pediatric Patients

Metabolic Acidosis
IV

Older children: 2–5 mEq/kg as an infusion over 4–8 hours in less urgent forms of metabolic acidosis. Subsequent doses should be determined by the response of the patient and appropriate laboratory determinations.

Plan sodium bicarbonate therapy in a stepwise manner, since the degree of response following a given dose is not always predictable. Reduce dose and frequency of administration after severe symptoms have improved.

Pediatric Resuscitation
IV/IO

Infants and children: Some experts recommend 1 mEq/kg administered slowly.

Ventricular arrhythmias associated with cocaine toxicity: Some experts recommended 1–2 mEq/kg.

Alkalinization of Urine
Oral

1–10 mEq (84–840 mg) per kg daily, adjusted according to response.

Adults

Metabolic Acidosis
IV

Initially, administer no more than 33–50% of the calculated bicarbonate requirements when initial, rapid administration of the drug is considered necessary. Consult specialized references on fluid and electrolyte and acid-base balance for specific recommendations.

2–5 mEq/kg dose as an infusion over 4–8 hours in less urgent forms of metabolic acidosis. Subsequent doses should be determined by the response of the patient and appropriate laboratory determinations. Therapy should be planned in a stepwise manner, since the degree of response following a given dose is not always predictable. Generally, the dose and frequency of administration should be reduced after severe symptoms have improved.

Diabetic Ketoacidosis
IV

Partially correct acidosis, generally to an arterial pH of about 7.2, in order to avoid rebound alkalosis.

ACLS
IV

If used in certain resuscitation situations (e.g., preexisting metabolic acidosis, hyperkalemia, tricyclic antidepressant overdosage), usual initial dose is 1 mEq/kg. Whenever possible, dosage should be guided by bicarbonate concentration or by calculated base deficit obtained from blood gas analysis or laboratory measurement. Complete correction of the base deficit not recommended to minimize risk of alkalosis.

For management of cardiac arrest due to hyperkalemia, 50 mEq has been administered IV over 5 minutes as adjunctive therapy to other standard ACLS measures.

Acidosis Associated with Chronic Renal Failure
Oral

Initially, 20–36 mEq daily, given in divided doses when plasma bicarbonate concentration is less than 15 mEq/L. Titrate dosage to provide a plasma bicarbonate concentration of about 18–20 mEq/L. To relieve symptoms and prevent or stabilize renal failure and osteomalacia in patients with renal tubular acidosis, higher dosages of sodium bicarbonate are necessary.

Distal (type 1) renal tubular acidosis: Initially, 0.5–2 mEq/kg daily, given in 4 or 5 divided doses. Titrate dosage until hypercalciuria and acidosis are controlled, and according to the response and tolerance of the patient. Alternatively, 48–72 mEq (about 4–6 g) daily.

Proximal (type 2) renal tubular acidosis: 4–10 mEq/kg daily, given in divided doses.

Alkalinization of Urine
Oral

Initially, 48 mEq (4 g), followed by 12–24 mEq (1–2 g) every 4 hours. Dosages of 30–48 mEq (2.5–4 g) every 4 hours, up to 192 mEq (16 g) daily, may be required in some patients. Titrate dosage to maintain the desired urinary pH.

Cautions for Sodium Bicarbonate

Contraindications

Warnings/Precautions

Warnings

CHF

Use with extreme caution in patients with CHF.

Fluid and/or Solute Overload

Possible fluid and/or solute overload following IV administration resulting in dilution of serum electrolytes, overhydration, congestive conditions, or pulmonary edema. Risk of dilutional conditions is inversely proportional to the electrolyte concentration administered. Risk of solute overload and resultant congestive conditions with peripheral and/or pulmonary edema is directly proportional to the electrolyte concentration administered.

Major Toxicities

Electrolyte Disturbances

Potassium depletion may predispose to metabolic alkalosis and coexistent hypocalcemia may result in tetany and carpopedal spasm as the plasma pH increases. Correct electrolyte disturbances prior to or concomitantly with administration of sodium bicarbonate therapy to minimize the risks of preexisting hypokalemia and/or hypocalcemia.

General Precautions

Dosing Considerations

Generally, the goal of alkalinizing therapy is to correct the acid-base disturbance while avoiding overdosage and resultant metabolic alkalosis. Frequent laboratory determinations and clinical evaluation of the patient are essential to monitor changes in fluid and electrolyte and acid-base balance.

Extravasation

Chemical cellulitis with inadvertent extravasation of hypertonic solutions, subsequently resulting in tissue necrosis, ulceration, and/or sloughing at the site of injection. Treat extravasation by elevating the affected area, applying warm compresses to the site, and locally injecting lidocaine or hyaluronidase.

Specific Populations

Pregnancy

Category C.

Pediatric Use

Neonates and children < 2 years of age: Rapid injection (10 mL/minute) of hypertonic sodium bicarbonate solutions may produce hypernatremia, decreased CSF pressure, and possible intracranial hemorrhage.

Renal Impairment

Use with extreme caution in patients with renal insufficiency, especially those with severe insufficiency such as oliguria or anuria.

When given in large doses or to patients with renal insufficiency, may cause metabolic alkalosis. Metabolic alkalosis may be accompanied by hyperirritability or tetany.

Common Adverse Effects

Gastric distention and flatulence with oral administration.

Drug Interactions

Specific Drugs

Drug

Interaction

Comments

Corticosteroids

Possible sodium retention with resulting edema

Use with extreme caution

Corticotropin

Possible sodium retention with resulting edema

Use with extreme caution

Stability

Storage

Oral

Tablets

Tight containers at 15–30°C.

Parenteral

Injection

15–30°C. Avoid freezing and extreme heat.

Compatibility

Parenteral

Solution CompatibilityHID

Compatible

Dextrose–Ringer’s injection combinations

Dextrose–Ringer’s injection, lactated, combinations

Dextrose–saline combinations

Dextrose 5% in sodium chloride 0.9%

Dextrose 2.5, 5, or 10% in water

Ionosol products

Ringer's injection

Sodium chloride 0.45 or 0.9%

Sodium lactate (1/6) M

Incompatible

Dextrose 5% in Ringer’s injection, lactated

Variable

Fat emulsion 10%, IV

Ringer’s injection, lactated

Drug Compatibility
Admixture CompatibilityHID

Compatible

Amikacin sulfate

Aminophylline

Amphotericin B

Atropine sulfate

Cefoxitin sodium

Ceftazidime

Ceftriaxone sodium

Chloramphenicol sodium succinate

Clindamycin phosphate

Cytarabine

Erythromycin lactobionate

Esmolol HCl

Furosemide

Heparin sodium

Hyaluronidase

Lidocaine HCl

Mannitol

Meperidine HCl

Methotrexate sodium

Methyldopate HCl

Multivitamins

Nafcillin sodium

Oxytocin

Phenylephrine HCl

Phytonadione

Potassium chloride

Prochlorperazine edisylate

Verapamil HCl

Incompatible

Ampicillin sodium

Ascorbic acid injection

Carboplatin

Carmustine

Ciprofloxacin

Cisplatin

Dobutamine HCl

Dopamine HCl

Epinephrine HCl

Ertapenem sodium

Imipenem–cilastatin sodium

Isoproterenol HCl

Labetalol HCl

Meropenem

Nicardipine HCl

Norepinephrine bitartrate

Pentazocine lactate

Pentobarbital sodium

Succinylcholine chloride

Voriconazole

Variable

Calcium chloride

Calcium gluconate

Levofloxacin

Magnesium sulfate

MIdazolam HCl

Penicillin G potassium

Y-Site CompatibilityHID

Compatible

Acyclovir sodium

Amifostine

Asparaginase

Aztreonam

Bivalirudin

Ceftaroline fosamil

Ceftriaxone sodium

Cladribine

Cyclophosphamide

Cytarabine

Daunorubicin HCl

Dexamethasone sodium phosphate

Dexmedetomidine HCl

Docetaxel

Doripenem

Doxorubicin HCl

Etoposide

Etoposide phosphate

Famotidine

Filgrastim

Fludarabine phosphate

Gallium nitrate

Gemcitabine HCl

Granisetron HCl

Heparin

Heparin sodium with hydrocortisone sodium succinate

Hydroxyethyl starch 130/0.4 in sodium chloride 0.9%

Ifosfamide

Indomethacin sodium trihydrate

Insulin, regular

Levofloxacin

Linezolid

Melphalan HCl

Mesna

Methylprednisolone sodium succinate

Milrinone lactate

Morphine sulfate

Paclitaxel

Pemetrexed disodium

Piperacillin sodium–tazobactam sodium

Potassium chloride

Propofol

Remifentanil HCl

Tacrolimus

Telavancin HCl

Teniposide

Thiotepa

Vancomycin HCl

Vasopressin

Incompatible

Allopurinol sodium

Amiodarone HCl

Amphotericin B cholesteryl sulfate complex

Anidulafungin

Calcium chloride

Doxorubicin HCl liposome injection

Fenoldopam mesylate

Hetastarch in lactated electrolyte injection (Hextend)

Idarubicin HCl

Imipenem–cilastatin sodium

Leucovorin calcium

Midazolam HCl

Nalbuphine HCl

Ondansetron HCl

Oxacillin sodium

Sargramostim

Verapamil HCl

Vincristine sulfate

Vinorelbine tartrate

Variable

Ciprofloxacin

Cisatracurium besylate

Diltiazem HCl

Actions

Advice to Patients

Preparations

Excipients in commercially available drug preparations may have clinically important effects in some individuals; consult specific product labeling for details.

Please refer to the ASHP Drug Shortages Resource Center for information on shortages of one or more of these preparations.

* available from one or more manufacturer, distributor, and/or repackager by generic (nonproprietary) name

Sodium Bicarbonate

Routes

Dosage Forms

Strengths

Brand Names

Manufacturer

Oral

Powder

Arm & Hammer Baking Soda

Church & Dwight

Tablets

325 mg*

Soda Mint

CMC

Sodium Bicarbonate Tablets

Parenteral

Injection

4.2% (0.5 mEq/mL) (2.5 or 5 mEq)*

Sodium Bicarbonate Injection

5% (0.595 mEq/mL) (297.5 mEq)*

Sodium Bicarbonate Injection

7.5% (0.892 mEq/mL) (8.92 or 44.6 mEq)*

Sodium Bicarbonate Injection

8.4% (1 mEq/mL) (10 or 50 mEq)*

Sodium Bicarbonate Injection

Injection, for preparation of IV admixtures

7.5% (0.892 mEq/mL) (178.4 mEq) pharmacy bulk package

Sodium Bicarbonate Injection MaxiVial

American Pharmaceutical Partners

Solution, sterile, to adjust pH of injections

4% (0.48 mEq/mL) (2.4 mEq)

Neut

Hospira

4.2% (0.5 mEq/mL) (2.5 mEq)

Sodium Bicarbonate Additive Solution

AHFS DI Essentials™. © Copyright 2024, Selected Revisions March 3, 2022. American Society of Health-System Pharmacists, Inc., 4500 East-West Highway, Suite 900, Bethesda, Maryland 20814.

† Off-label: Use is not currently included in the labeling approved by the US Food and Drug Administration.

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