Sodium bicarbonate parenteral infusion
- Drugs List
- Therapeutic Indications
- Dosage
- Administration
- Contraindications
- Precautions and Warnings
- Pregnancy and Lactation
- Side Effects
- Monograph
Presentation
Infusions containing sodium bicarbonate.
Drugs List
Therapeutic Indications
Uses
Hyperkalaemia
Metabolic acidosis
Rapid alkalinisation of urine
Treatment of lactate acidosis
Dosage
Adults
The volume, strength and rate of infusion will depend on the requirements of the individual patient.
The average dose for less urgent forms of metabolic acidosis is 2mmol to 5mmol of bicarbonate per kg bodyweight administered intravenously over 4 to 8 hours. Subsequent doses should be adjusted to the requirements of the patient.
Treatment should be initiated with half the calculated dose. This may then be adjusted according to blood gas analysis.
A blind buffer therapy may only be performed in life threatening situations.
Children
Metabolic acidosis
A reduced volume, strength and rate of infusion is necessary in children.
Alternative sources suggest administration by continuous intravenous infusion of a weaker solution of sodium bicarbonate (usually 1.26%), appropriate to the body base deficit.
Persistent cyanotic episode in a child with a congenital heart defect despite optimal use of 100% oxygen and propranolol (unlicensed)
Children aged over 1 year: 1mmol/kg sodium bicarbonate 8.4%
Children aged under 1 year: 1mmol/kg sodium bicarbonate 4.2%
Administration
For intravenous infusion.
Sodium bicarbonate 8.4% infusion should be administered via a central vein only.
Contraindications
Cardiac impairment
Eclampsia
Hypernatraemia
Hypertension
Hypocalcaemia
Hypokalaemia
Metabolic alkalosis
Pulmonary oedema
Renal impairment
Respiratory alkalosis
Respiratory depression
Precautions and Warnings
Breastfeeding
Pregnancy
Correct serum calcium levels before commencing treatment
Avoid circulatory overload
If extravasation occurs follow local policy & seek expert help immediately
Correct serum potassium levels before commencing treatment
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 periodically for signs of hypokalaemia
Monitor serum electrolytes
Monitor serum osmolarity
Pregnancy and Lactation
Pregnancy
Use sodium bicarbonate with caution during 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
Hypernatraemia
Venous thrombosis
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 4.2% solution for infusion. B Braun. Revised May 2013.
Summary of Product Characteristics: Sodium Bicarbonate 8.4%. solution for infusion. B Braun. Revised May 2013.
Summary of Product Characteristics: Sodium Bicarbonate Infusion 1.4% Polyfusor BD.Fresenius Kabi Ltd. Revised January 2000.
Summary of Product Characteristics: Sodium Bicarbonate Infusion 1.26% Polyfusor BC. Fresenius Kabi Ltd. Revised November 1999.
Summary of Product Characteristics: Sodium Bicarbonate Infusion 2.74% Polyfusor V. Fresenius Kabi Ltd. Revised November 1999.
Summary of Product Characteristics: Sodium Bicarbonate Infusion 4.2% Polyfusor BE. Fresenius Kabi Ltd. Revised November 1999.
Summary of Product Characteristics: Sodium Bicarbonate Infusion 8.4% Polyfusor. Fresenius Kabi Ltd. Revised November 1999.
NICE Evidence Services Available at: www.nice.org.uk Last accessed: 7 September 2017
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