Sodium Bicarbonate Injection

What is Sodium Bicarbonate Injection?
Sodium Bicarbonate Injection is a sterile, non-pyrogenic, hypertonic solution used as a systemic and urinary alkalinizing agent.6 It belongs to the class of electrolyte replenishers and is critical in emergency medicine for restoring the body's acid-base balance during severe clinical instabilities where the blood has become too acidic.7
 
Uses of Sodium Bicarbonate Injection
Treatment of metabolic acidosis associated with cardiac arrest, severe renal disease, or uncontrolled diabetes.8
 
Management of circulatory insufficiency due to shock or severe dehydration.9
 
Alkalinization of urine to increase the solubility of certain weak acids (e.g., uric acid) and prevent crystal formation.10
 
Treatment of certain drug intoxications, such as barbiturate, salicylate, or methyl alcohol poisoning.11
 
Emergency management of severe hyperkalemia (high potassium levels) to shift potassium into cells.12
 
How Does Sodium Bicarbonate Injection Work?
After intravenous administration, the drug dissociates into sodium (13$Na^+$) and bicarbonate (14$HCO_3^-$) ions.15 The bicarbonate ions act as a buffer by reacting with excess hydrogen ions (16$H^+$) in the blood to form water (17$H_2O$) and carbon dioxide (18$CO_2$), which is then excreted via the lungs.19 This reaction effectively raises the pH of the blood and urine.20
 
FAQs on Sodium Bicarbonate Injection
1. Is Sodium Bicarbonate Injection used routinely during CPR?
No, it is no longer recommended for routine use during standard cardiac arrest.21 It is specifically reserved for cases where the arrest is caused by pre-existing metabolic acidosis, hyperkalemia, or a tricyclic antidepressant overdose.22
2. Can it be administered through any vein?
While it can be given via peripheral veins in emergencies, highly concentrated solutions (like 23$8.4\%$) are ideally administered through a central line.24 This is because the solution is hypertonic and can cause significant venous irritation or tissue damage if it leaks outside the vein (extravasation).25
3. Why must it not be mixed with Calcium injections?
Sodium Bicarbonate is chemically incompatible with calcium salts (like Calcium Gluconate).26 Mixing them in the same IV line or syringe will cause the formation of a calcium carbonate precipitate (a solid chalk-like substance), which can be dangerous if injected.
4. What are the common side effects to monitor?
Healthcare providers must monitor for signs of metabolic alkalosis (excessive alkalinity), decreased potassium levels (hypokalemia), and fluid overload, which can lead to swelling or pulmonary edema in patients with heart or kidney issues.27
Therapeutic Category
Others (Electrolytes & Systemic Alkalinizers)
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