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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 dysrhythmias: (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.


Caution with rapid infusion of hypertonic solutions in neonates and small children: hypernatremia and hyperosmolality may occur. Titrate carefully to achieve plasma or urine pH goals. Note: 8.4 % Sodium Bicarbonate = 1 mmol/mL or 1 mEq/mL and and 4.2 % Sodium Bicarbonate = 0.5 mmol/mL or 0.5 mEq/mL

  • Drug or toxin-induced wide complex dysrrhythmias:

    Neonates and children less than 2 years: 1 mmol/kg IV direct over 1 - 2 minutes [use 2 mL/kg of 0.5 mmol/mL (4.2%) solution to decrease osmotic load].
    Children greater than 2 years: 1 mmol/kg IV direct over 1 - 2 minutes.
    -Repeat bolus as required to improve signs of cardiac toxicity (QRS greater than 100 ms, hypotension, wide complex dysrrhythmias). 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: Infuse a 0.15 mmol/mL sodium bicarbonate solution at 2 - 3 mL/kg/hour. 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: Rapid injection of greater than 10 mL/minute of hypertonic sodium bicarbonate in neonates and children under 2 years old may produce hypernatremia, decreased cerebral spinal fluid pressure and may result in intracranial hemorrhage.

    Neonates and children less than 2 years:
    -0.5 mmol/mL (4.2%) solution undiluted or to prepare a 0.5 mmol/mL solution dilute 1 mmol/mL (8.4%) solution 1:1 in sterile water.
    - Neonates and infants: Maximum rate: 10 mmol/minute.
    - Children greater than or equal to 2 years: 1 mmol/mL (8.4%) solution undiluted.
    - Blood pressure monitoring, blood gas (acid-base) monitoring, serum electrolyte monitoring and respiratory support are required.
  • Infusion: For a final concentration of 0.15 mmol/mL: add 150 mmol (150 mL of mmol/mL (8.4%) sodium bicarbonate) to 850 mL of dextrose 5% in water. May administer up to 0.5 mmol/mL solution in peripheral line.
    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 bicarbonate = 0.5 mmol/mL.

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