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Poisoning Information for the Public & Health Care Professionals
Last updated: 05/2019

Sodium Bicarbonate


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Sodium Bicarbonate



  • Drug or toxin-induced wide complex dysrhythmia (e.g; tricyclic antidepressants).
  • Toxin-induced metabolic acidosis (e.g; methanol, ethylene glycol, salicylate, metformin).
  • Alkalinization of the urine to enhance drug elimination (e.g; salicylate, chlorphenoxy herbicides, phenobarbital, methotrexate) or to prevent nephrotoxicity from rhabdomyolysis.
  • Adjunctive therapy for chlorine gas inhalation with respiratory symptoms


Note: 8.4 % Sodium Bicarbonate = 1 mmol/mL or 1 mEq/mL

  • Drug or toxin-induced wide complex dysrhythmia: 1 - 2 mmol/kg (50 - 100 mL of sodium bicarbonate 8.4%) IV direct over 1 - 2 minutes. Repeat as required to improve signs of cardiac toxicity (e.g; QRS greater than 100 ms, hypotension, wide complex dysrhythmia). Do not exceed a serum pH of 7.55.
  • Toxin-induced metabolic acidosis: 0.5 - 1 mmol/kg IV direct. Repeat as required to maintain serum pH greater than 7.20.
  • Urine alkalinization: Administer a solution of 0.15 mmol/mL at 150 - 200 mL/hour (see Administration section).
    -Goal is a urine pH of greater than 7.5.
    -Correction of hypokalemia is required to achieve alkaline diuresis.
  • Chlorine gas-induced inhalational injury: 4 mL of a 4.2% sodium bicarbonate solution by nebulizer. One dose is often adequate; repeat doses may be necessary in more severe cases. Contact the poison centre for guidance.


  • IV Direct: May be administered undiluted (8.4% solution) in emergency situations at a rate not exceeding 1 mmol/kg/minute. Blood pressure monitoring, blood gas (acid-base) monitoring, serum electrolyte monitoring and respiratory support are required.
  • Infusion: Add 150 mL sodium bicarbonate 8.4% injection to 850 mL dextrose 5% in water for a final concentration of 0.15 mmol/mL. Blood gases (acid-base balance) and serum electrolytes must be monitored.
  • Nebulization: For a final concentration of 4.2%: add 2 mL of 8.4% sodium bicarbonate solution to 2 mL of sterile water.

Compatibility, Stability

  • Compatible with sodium chloride 0.9% and dextrose 5% in water.

Potential Hazards of Administration

  • Phlebitis (especially with direct administration).
  • Alkalosis, hypernatremia, edema (especially patients with cardiac, renal, and hepatic insufficiency), hypokalemia, hyperosmolality.
  • Hypocalcemia, tetany, neuromuscular hyperactivity.


  • 8.4% solution contains 1 mmol/mL of sodium bicarbonate. Each 84 mg of sodium bicarbonate provides 1 mmol (1 mEq) of sodium and bicarbonate ions.
  • 4.2% sodium bicarbnonate provides 0.5 mmol/mL.

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Vajner 111, J. E., & Lung, D. (2013). Case files of the university of California San Francisco medical toxicology fellowship: Acute chlorine gas inhalation and the utility of nebulized sodium bicarbonate. Journal of Medical Toxicology, 9, 259-265.