ADULTS
Indication
|
Dosing
|
Reference
|
Metabolic Acidosis (less severe)
|
IV: Dosage should be based on the
following formula if blood gases and pH measurements are available:
HCO3-(mEq) = 0.5 x weight (kg) x [24 -
serum HCO3-(mEq/L)] or HCO3-(mEq) = 0.5 x weight (kg) x [desired increase in
serum HCO3-(mEq/L)]
Administer 1/2 dose initially, then
remaining 1/2 dose over the next 24 hours; monitor pH, serum HCO3-, and
clinical status. Note: These equations provide an estimated replacement dose.
The underlying cause and degree of acidosis may result in the need for larger
or smaller replacement doses. In most cases, the initial goal of therapy is
to target a pH of ~7.2 and a plasma bicarbonate level of ~10 mEq/L to prevent
over alkalinization. According to the ARDSNet protocol, if pH remains
<7.15 after ventilator adjustments, may give NaHCO3 (Brower 2004).
If acid-base status is not available:
2 to 5 mEq/kg IV infusion over 4 to 8
hours; subsequent doses should be based on patient's acid-base status.
|
UptoDate
|
Non-life-threatening:
• 2-5
mEq/kg IV infusion over 4-8 hr depending on the severity of acidosis as
judged by the lowering of total CO2 content, clinical condition and pH
|
Medscape
|
|
If acid-base status is available, dosages
should be calculated as follows:
0.2 x weight (kg) x base deficit.
Alternatively:
HCO3 (mEq) required = 0.5 x weight (kg)
x [24 - serum HCO3 (mEq/L)].
or
Moderate metabolic acidosis:
50 to 150 mEq sodium bicarbonate
diluted in 1 L of D5W to be intravenously infused at a rate of 1 to 1.5
L/hour during the first hour.
If acid-base status is not available,
dosages should be calculated as follows:
2 to 5 mEq/kg IV infusion over 4 to 8
hours; subsequent doses should be based on patient's acid-base status.
|
Drugs.com
https://www.drugs.com/dosage/sodium-bicarbonate.html
[Accessed 8 May 2020]
|
|
In the treatment of chronic acidosis
bicarbonate has been given orally and doses providing 57 mmol (4.8 g sodium
bicarbonate) or more daily may be required.
The dose of bicarbonate required for
the treatment of acidotic states must be calculated on an individual basis,
and is dependent on the acid–base balance and electrolyte status of the
patient.
|
Martindale 36th Edition
|
|
In less urgent forms of metabolic
acidosis,
Sodium Bicarbonate Injection, USP may
be added to other intravenous fluids. The amount of bicarbonate to be given
to older children and adults over a four-to eight- hour period is
approximately 2 to 5 mEq/kg of body weight — depending upon the severity of the
acidosis as judged by the lowering of total CO2 content, blood pH and
clinical condition of the patient. Bicarbonate therapy should always be
planned in a stepwise fashion since the degree of response from a given dose
is not precisely predictable. Initially an infusion of 2 to 5 mEq/kg body
weight over a period of 4 to 8 hours will produce a measurable improvement in
the abnormal acid-base status of the blood. The next step of therapy is
dependent upon the clinical response of the patient. If severe symptoms have
abated, then the frequency of administration and the size of the dose may be
reduced
|
Dailymed.nlm.nih.gov
dailymed.nlm.nih.gov/dailymed/fda/fdaDrugXsl.cfm?setid=2d05e1e4-0891-411d-a435-1280991fa79f&type=display
|
|
Metabolic Acidosis (severe)
|
Severe (except hypercarbic
acidosis):
• 90-180
mEq/L (~7.5-15 g) at a rate of 1-1.5 L (first hour); adjust for further
management as needed
|
Medscape
|
Severe metabolic acidosis:
90 to 180 mEq sodium bicarbonate
diluted in 1 L of D5W to be intravenously infused at a rate of 1 to 1.5
L/hour during the first hour.
|
Drugs.com
https://www.drugs.com/dosage/sodium-bicarbonate.html
[Accessed 8
May 2020]
|
|
Sodium bicarbonate has been given
intravenously by continuous infusion usually as a 1.26% (150 mmol/litre)
solution or by slow intravenous injection of a stronger (hypertonic) solution
of up to 8.4% (1000 mmol/litre) sodium bicarbonate.
|
Martindale 36th Edition
|
|
Hyperkalaemia
|
IV: 50 mEq over 5 minutes (as
appropriate, consider methods of enhancing potassium removal/excretion)
|
ACLS 2010
|
IV: 50 mEq over 5 minutes
|
Medscape
|
|
50 mmol of sodium bicarbonate infused
slowly over 5 minutes; may repeat in 30 minutes if needed.
• May lower plasma K+ within 30–60 minutes and
persist for several hours.
• The efficacy of bicarbonate is disputed, it seems
least effective in patients with advanced kidney disease; may be preferred
and effective in patients with underlying metabolic acidosis.
|
CRITICAL CARE PHARMACY HANDBOOK, First Edition, 2013
Pharmaceutical
Services Division, MOH, Malaysia
|
|
If the patient is acidotic, give sodium
bicarbonate (NaHCO3) 50–100 mmol over 1 h but be aware of the usual risks of
bicarbonate administration, including fluid overload, worsening of
intracellular and cerebrospinal fluid (CSF) acidosis, acute ionized hypocalcemia,
and increased carbon dioxide production.
Sodium bicarbonate should be used only
when acidosis is severe (pH <7.1), the patient is symptomatic, or if
acidosis is associated with acute hyperkalaemia. The need for bicarbonate is
an indication for dialysis.
|
Handbook of Critical Care, Third
Edition, 2009
(University of Chicago)
|
|
Urgent treatment of hyperkalaemia :
100 ml 8.4% sodium bicarbonate intravenously.
|
Handbook of Critical Care Medicine,
2009
|
|
Cardiac Arrest
|
IV: Initial: 1 mEq/kg/dose; repeat
doses should be guided by arterial blood gases
Routine use of NaHCO 3 is not
recommended. May be considered in the setting of prolonged cardiac arrest
only after adequate alveolar ventilation has been established and effective
cardiac compressions. Note: In some cardiac arrest situations (eg, metabolic
acidosis, hyperkalemia, or tricyclic antidepressant overdose), sodium
bicarbonate may be beneficial.
|
ACLS 2010
|
Initial: 1 mEq/kg/dose IV x1; base
subsequent doses on results of arterial blood pH and PaCO2 as well as
calculation of base deficit
• Repeat
doses may be considered in the setting of prolonged cardiac arrest only after
adequate alveolar ventilation has been established
|
Medscape
https://reference.medscape.com/drug/sodium-bicarbonate-342305
[Accessed 8
May 2020]
|
|
A rapid intravenous dose of 200 to 300
mEq of bicarbonate, given as a 7.5% or 8.4% solution is suggested for adults.
Cautions should be observed in emergencies where very rapid infusion of large
quantities of bicarbonate is indicated. Bicarbonate solutions are hypertonic
and may produce an undesirable rise in plasma sodium concentration in the
process of correcting the metabolic acidosis. In cardiac arrest, however, the
risks from acidosis exceed those of hypernatremia.
|
Dailymed.nlm.nih.gov
dailymed.nlm.nih.gov/dailymed/fda/fdaDrugXsl.cfm?setid=2d05e1e4-0891-411d-a435-1280991fa79f&type=display
|
PAEDIATRICS
Indication
|
Dosing
|
Reference
|
Metabolic Acidosis
|
Acute metabolic acidosis in Infants,
Children, and Adolescents:
Blood-gas
directed dosing (equations): IV:
These equations provide an estimated
replacement dose. The underlying cause and degree of acidosis may result in
the need for larger or smaller replacement doses. In most cases, the initial
goal of therapy is to target a pH of ~7.2 to prevent overalkalinization
(Androgue 2006; Furhman 2011).
HCO3-(mEq) = 0.3 x weight (kg) x base
deficit (mEq/L) or
HCO3-(mEq) = 0.5 x weight (kg) x [24 -
serum HCO3-(mEq/L)]
Administer 1/2 calculated dose
initially, then remaining 1/2 dose over the next 24 hours; monitor pH, serum
HCO3-, and clinical status
Weight-directed dosing (if acid-base
status is not available): Infants, Children, and Adolescents: IV,
Intraosseous: 1 to 2 mEq/kg/dose (Hegenbarth 2008), in older Children (>2
years) and Adolescents: 2 to 5 mEq/kg IV infusion over 4 to 8 hours;
subsequent doses should be based on patient's acid-base status
|
UptoDate
|
Older children:
·
2-5 mEq/kg IV
infusion over 4-8 hr depending on the severity of acidosis as judged by the
lowering of total CO2 content, clinical condition and pH
·
0.25-2mEq/kg IV
infusion can be considered for acidosis with a pH <7.0-7.2
|
Medscape
https://reference.medscape.com/drug/sodium-bicarbonate-342305
[Accessed 8
May 2020]
|
|
If acid-base status is available,
dosages should be calculated as follows:
Infants and Children:
HCO3 (mEq) required = 0.3 x weight (kg)
x base deficit (mEq/L) OR HCO3 (mEq) required = 0.5 x weight (kg) x [24 -
serum HCO3 (mEq/L)].
If acid-base status is not available,
dosages should be calculated as follows:
Older children: 2 to 5 mEq/kg IV
infusion over 4 to 8 hours; subsequent doses should be based on patient
acid-base status.
|
Drugs.com
https://www.drugs.com/dosage/sodium-bicarbonate.html
[Accessed 8
May 2020]
|
|
In infants (up to two years of age),
Intravenous administration at a dose
not to exceed 8 mEq/kg/day is recommended. Slow administration rates and a
solution diluted to 4.2% are recommended in neonates, to guard against the
possibility of producing hypernatremia, decreasing cerebrospinal fluid
pressure and inducing intracranial hemorrhage.
|
Dailymed.nlm.nih.gov
dailymed.nlm.nih.gov/dailymed/fda/fdaDrugXsl.cfm?setid=2d05e1e4-0891-411d-a435-1280991fa79f&type=display
|
|
Hyperkalaemia
|
Hyperkalaemia (adjunct)
IV: 1 to 2 mEq/kg/dose has been used to redistribute
extracellular potassium into cells based on physiologic understanding
(Hegenbarth 2008); however, some data has shown efficacy lacking for use in
acute, early treatment of hyperkalemia (ie, 60 minutes); in adult dialysis
patients, while short infusions were shown to increase serum bicarbonate,
they were not shown to reduce serum potassium (Ahee 2000; Blumberg 1988;
Gutierrez 1991; Kim 1996; Weisberg 2008); some efficacy was observed with a
long duration hypertonic bicarbonate infusion (eg, 150 mEq/L in D5W) used as
rehydration fluid and/or in presence of metabolic acidosis (Weiner 1998;
Weisberg 2008); serum Na should also be monitored closely
|
UptoDate
|
Cardiac Arrest
|
Infants,
<2 years (use 4.2% solution)
Initial: 1 mEq/kg/min given over 1-2 minutes IV/IO, THEN 1
mEq/kg IV q10min of arrest
Not to exceed 8 mEq/kg/day
≥2 years
Initial: 1 mEq/kg/dose IV x1; base subsequent doses on results
of arterial blood pH and PaCO2 as well as calculation of base deficit
Repeat doses may be considered in the setting of prolonged
cardiac arrest only after adequate alveolar ventilation has been established
|
Medscape
|
Infants, Children, and Adolescents:
IV, Intraosseous: 1 mEq/kg/dose; repeat doses should be guided
by arterial blood gases; in infants and children <2 years of age, the 4.2%
(0.5 mEq/mL) solution should be used. Note: If intraosseous route is used for
administration and is subsequently used to obtain blood samples for acid-base
analysis, results will be inaccurate (AHA [Kleinman 2010).
|
PALS guidelines (under UptoDate)
|
Availability in Hospital Keningau:
Sodium Bicarbonate 8.4% Injection
1 mL = 1 mEq = 1 mmol
All accessed on 8 May
2020 [Prepared by Zulhelmy ; Edited by JCK Ho]
