Drugs List

Therapeutic Indications

Uses

Metabolic acidosis

Correction of 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.

Treatment of metabolic acidosis associated with cardiac arrest after other resuscitative measures have been used. Other measures may include cardiac compression, ventilation, adrenaline and antiarrhythmics agents.

Unlicensed Uses

Hyperkalaemia

Administration

For intravenous administration.

Contraindications

Oedema
Congestive cardiac failure
Eclampsia
History of nephrolithiasis
Hypernatraemia
Hypertension
Hypocalcaemia
Hypochloraemia
Hypokalaemia
Metabolic alkalosis
Nephrolithiasis
Renal impairment
Respiratory alkalosis
Respiratory depression

Precautions and Warnings

Breastfeeding
Pregnancy

If extravasation occurs follow local policy & seek expert help immediately
Monitor blood carbon dioxide levels before and during treatment
Monitor acid-base balance
Monitor arterial and venous blood pH
Monitor blood gases regularly
Monitor fluid balance
Monitor serum electrolytes
Monitor serum osmolarity

Pregnancy and Lactation

Pregnancy

May only be used during pregnancy if expected benefits of treatment outweigh possible risks to the patient and child.

Safety has not been established.

The use of all medication in pregnancy should be avoided whenever possible; particularly in the first trimester. Non-drug treatments should also be considered. When essential, a medication with the best safety record over time should be chosen, employing the lowest effective dose for the shortest possible time. Polypharmacy should be avoided. Teratogens taken in the pre-embryonic period, often quoted as lasting until 14 to 17 days post-conception, are believed to have an all-or-nothing effect. Where drugs have a short half-life, and when the date of conception is certain, this may allow women to be reassured where drug exposure has occurred within this time frame. Further advice may be available from the UK National Teratology Information Service (NTIS) and through ToxBase, available via password on the internet ( www.toxbase.org ) or if this is unavailable at the backup site ( www.toxbasebackup.org ).

Lactation

Use sodium bicarbonate with caution in breastfeeding if expected benefits of treatment outweigh possible risks.

Patients requiring therapy with sodium bicarbonate are likely to be too ill to breast feed.

Neonates, infants born prematurely, those with low birth weight, those with an unstable gastrointestinal function or who have serious illnesses may require special consideration. For any infant, if a drug is prescribed to the nursing mother, it should be at the lowest practical dose and for the shortest time. When drug administration is unavoidable and breastfeeding is to continue, minimisation of exposure of the infant to the drug may sometimes be achieved by timing the maternal doses to just after a feeding episode. Infants exposed to drugs via breast milk should be monitored for unusual signs or symptoms. Interactions between the drug received by the infant from the mother's milk and medication prescribed for the infant should also be considered, for example, when the drug given to the infant may prevent metabolism of the drug received via breast milk.
Specialist advice is available from the UK Drugs in Lactation Advisory Service at https://www.midlandsmedicines.nhs.uk/content.asp?section=6&subsection=17&pageIdx=1

Side Effects

Alkalosis
Cerebral haemorrhage
Extravasation
Hypernatraemia
Hypocalcaemia
Hypoglycaemia
Hypokalaemia
Irritability
Paradoxical intracellular acidosis
Skin exfoliation
Soft tissue necrosis
Tetany

Presentation

Injections containing sodium bicarbonate.

Drugs List

Therapeutic Indications

Uses

Metabolic acidosis

Correction of 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.

Treatment of metabolic acidosis associated with cardiac arrest after other resuscitative measures have been used. Other measures may include cardiac compression, ventilation, adrenaline and antiarrhythmics agents.

Unlicensed Uses

Hyperkalaemia

Dosage

Arterial blood gases should be monitored before and during treatment to minimise the risk of overdosage and consequent alkalosis. In particular, arterial/venous blood pH and carbon dioxide levels should be monitored.

Adults

Children

Neonates

Administration

For intravenous administration.

Contraindications

Oedema
Congestive cardiac failure
Eclampsia
History of nephrolithiasis
Hypernatraemia
Hypertension
Hypocalcaemia
Hypochloraemia
Hypokalaemia
Metabolic alkalosis
Nephrolithiasis
Renal impairment
Respiratory alkalosis
Respiratory depression

Precautions and Warnings

Breastfeeding
Pregnancy

If extravasation occurs follow local policy & seek expert help immediately
Monitor blood carbon dioxide levels before and during treatment
Monitor acid-base balance
Monitor arterial and venous blood pH
Monitor blood gases regularly
Monitor fluid balance
Monitor serum electrolytes
Monitor serum osmolarity

Pregnancy and Lactation

Pregnancy

May only be used during pregnancy if expected benefits of treatment outweigh possible risks to the patient and child.

Safety has not been established.

The use of all medication in pregnancy should be avoided whenever possible; particularly in the first trimester. Non-drug treatments should also be considered. When essential, a medication with the best safety record over time should be chosen, employing the lowest effective dose for the shortest possible time. Polypharmacy should be avoided. Teratogens taken in the pre-embryonic period, often quoted as lasting until 14 to 17 days post-conception, are believed to have an all-or-nothing effect. Where drugs have a short half-life, and when the date of conception is certain, this may allow women to be reassured where drug exposure has occurred within this time frame. Further advice may be available from the UK National Teratology Information Service (NTIS) and through ToxBase, available via password on the internet ( www.toxbase.org ) or if this is unavailable at the backup site ( www.toxbasebackup.org ).

Lactation

Use sodium bicarbonate with caution in breastfeeding if expected benefits of treatment outweigh possible risks.

Patients requiring therapy with sodium bicarbonate are likely to be too ill to breast feed.

Neonates, infants born prematurely, those with low birth weight, those with an unstable gastrointestinal function or who have serious illnesses may require special consideration. For any infant, if a drug is prescribed to the nursing mother, it should be at the lowest practical dose and for the shortest time. When drug administration is unavoidable and breastfeeding is to continue, minimisation of exposure of the infant to the drug may sometimes be achieved by timing the maternal doses to just after a feeding episode. Infants exposed to drugs via breast milk should be monitored for unusual signs or symptoms. Interactions between the drug received by the infant from the mother's milk and medication prescribed for the infant should also be considered, for example, when the drug given to the infant may prevent metabolism of the drug received via breast milk.
Specialist advice is available from the UK Drugs in Lactation Advisory Service at https://www.midlandsmedicines.nhs.uk/content.asp?section=6&subsection=17&pageIdx=1

Side Effects

Alkalosis
Cerebral haemorrhage
Extravasation
Hypernatraemia
Hypocalcaemia
Hypoglycaemia
Hypokalaemia
Irritability
Paradoxical intracellular acidosis
Skin exfoliation
Soft tissue necrosis
Tetany

Overdosage

It is strongly recommended that the UK National Poisons Information Service be consulted on cases of suspected or actual overdose where there is doubt over the degree of risk or about appropriate management.

The following number will direct the caller to the relevant local centre (0844) 892 0111

Information may be obtained if you have access to ToxBase the primary clinical toxicology database of the National Poisons Information Service. This is available via password on the internet ( www.toxbase.org ) or if this is unavailable at the backup site ( www.toxbasebackup.org ).

Further Information

Last Full Review Date: August 2013

Reference Sources

Summary of Product Characteristics: Sodium Bicarbonate Injection Minijet 8.4% Ltd. Revised May 2013.
Summary of Product Characteristics: Sodium Bicarbonate Injection 8.4%. Martindale Pharmaceuticals. Revised July 2004.
Summary of Product Characteristics: Sodium Bicarbonate Injection 8.4%, Aurum Pharmaceuticals. Revised September 2001.

NICE Evidence Services Available at: www.nice.org.uk Last accessed: 19 September 2017