Sodium Bicarbonate

Liverpool Hospital Emergency Department


  • Sodium Channel Blocker overdose with QRS widening and CNS depression
    • TCA /  Bupropion / Chloroquine / Local Anaesthetics / Propranolol / Class 1 antiarrhythmics  e.g. flecainide quinidine quinine
  • Urinary Alkalinisation in Salicylate overdose & Chlorophenoxy Herbicide Poisoning

  • It can be considered in the treatment of  severe metabolic acidosis as a bridging therapy pending haemodialysis
    • severe acidosis with poor response to inotropy (to increase inotrope  effectiveness – generally pH <7) 
    • Severe acidosis prior to induction as a buffer during predicted risk of  worsening acidosis
  • Hyperkalaemia (e.g. potassium overdose / digoxin overdose 


  • 8.4% 100ml bottle 1mmol/ml 

Dosage and Administration 

  • TCA poisoning prior to the induction of anaesthesia 
    • 1-2mmol/kg as single bolus dose prior to institution of hyperventilation
  • Sodium Channel blocker overdose with QRS widening
    • 1-2mmol/kg as bolus prior to institution of hyperventilation

Max dose in boluses 6mmol/kg

  • Urinary alkalinisation
    • 1mmol/kg bolus followed by an infusion
    • Infusion 150mmol (150ml NaHCO3 + 850ml 5% Dextrose) 166ml/hr aiming  for urinary pH >7.5 (do not exceed a serum pH of 7.5)
    • Maintain normokalaemia
  • Hyperkalaemia:
    • 50ml bolus over 5-10 minutes repeat after 15 minutes

Side Effects: 

  • Pulmonary oedema
  • Hypokalaemia
  • Metabolic or respiratory alkalosis
  • Hypernatraemia
  • Renal failure
  • Extravasation and phlebitis 

Pit Falls 

  • This is a temporising measure until hyperventilation can be performed aiming for a  pH 7.45-7.55 in the case of sodium channel blocker overdose
  • Do not give repeated doses of NaHCO3 unless there is a clear QRS response o Avoid pH >7.55
  • Avoid hypernatraemia