Get your patient on Sodium Bicarbonate - Sodium Bicarbonate injection, Solution (Sodium Bicarbonate)

Sodium Bicarbonate Injection is indicated in the treatment of metabolic acidosis which may occur in severe renal disease, uncontrolled diabetes, circulatory insufficiency due to shock or severe dehydration, extracorporeal circulation of blood, cardiac arrest and severe primary lactic acidosis.

Sodium bicarbonate is further indicated in the treatment of certain drug intoxications, including barbiturates (where dissociation of the barbiturate-protein complex is desired), in poisoning by salicylates or methyl alcohol and in hemolytic reactions requiring alkalinization of the urine to diminish  nephrotoxicity  of  hemoglobin and  its  breakdown products.  Sodium bicarbonate  also  is  indicated  in  severe  diarrhea  which  is  often  accompanied  by  a  significant  loss  of  bicarbonate.

Treatment of  metabolic  acidosis  should,  if  possible,  be  superimposed  on measures  designed  to  control  the  basic  cause  of  the  acidosis  -  e.g., insulin in uncomplicated diabetes, blood volume  restoration in  shock. But since  an appreciable  time  interval  may elapse  before  all  of  the  ancillary effects  are  brought  about,  bicarbonate  therapy  is  indicated  to  minimize  risks  inherent  to  the  acidosis  itself.

Vigorous  bicarbonate  therapy  is  required  in  any  form  of  metabolic  acidosis  where  a  rapid  increase  in  plasma total  CO2  content is  crucial  -  e.g., cardiac  arrest, circulatory insufficiency due  to  shock or  severe  dehydration,  and  in  severe  primary  lactic  acidosis  or  severe  diabetic  acidosis.

Sodium Bicarbonate Injection is administered by the intravenous route.

In cardiac arrest, a rapid intravenous dose of one to two 50 mL vials (44.6 to 100 mEq) may be given initially and continued at a rate of 50 mL (44.6 to 50 mEq) every 5 to 10 minutes if necessary (as indicated by arterial pH and blood gas monitoring) to reverse the acidosis. Caution 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.

In less urgent forms of metabolic acidosis, Sodium Bicarbonate Injection 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 CO ₂ content, blood pH and clinical condition of the patient. In metabolic acidosis associated with shock, therapy should be monitored by measuring blood gases, plasma osmolarity, arterial blood lactate, hemodynamics and cardiac rhythm. 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.

In general, it is unwise to attempt full correction of a low total CO ₂ content during the first 24 hours of therapy, since this may be accompanied by an unrecognized alkalosis because of a delay in the readjustment of ventilation to normal. Owing to this lag, the achievement of total CO ₂ content of about 20 mEq/liter at the end of the first day of therapy will usually be associated with a normal blood pH. Further modification of the acidosis to completely normal values usually occurs in the presence of normal kidney function when and if the cause of the acidosis can be controlled. Values for total CO ₂ which are brought to normal or above normal within the first day of therapy are very likely to be associated with grossly alkaline values for blood pH, with ensuing undesired side effects.

Parenteral drug products should be inspected visually for particulate matter and discoloration prior to administration, whenever solution and container permit. See PRECAUTIONS.

Discard unused portion.

Sodium Bicarbonate  Injection is  contraindicated in patients  who  are  losing  chloride  by vomiting  or  from continuous  gastrointestinal suction, and in patients  receiving  diuretics  known to  produce  a  hypochloremic  alkalosis.

Overly aggressive therapy with Sodium Bicarbonate Injection, can result in metabolic alkalosis (associated with muscular twitchings, irritability and tetany) and hypernatremia.

Inadvertent extravasation of intravenously administered hypertonic solutions of sodium bicarbonate have been reported to cause chemical cellulitis because of their alkalinity, with tissue necrosis, ulceration or sloughing at the site of infiltration. Prompt elevation of the part, warmth and local injection of lidocaine or hyaluronidase are recommended to reduce the likelihood of tissue sloughing from extravasated I.V. solutions.

Additives  may be  incompatible; norepinephrine  and dobutamine  are  incompatible  with sodium  bicarbonate  solution.

The  addition of  sodium bicarbonate  to  parenteral  solutions  containing  calcium should be  avoided,  except  where  compatibility  has  been previously  established.  Precipitation or  haze  may  result  from  sodium  bicarbonate-calcium  admixtures. NOTE: Do  not  use  the  injection  if  it  contains  precipitate.

Additives  may  be  incompatible.  Consult  with  pharmacist,  if  available.  When  introducing  additives,  use  aseptic  technique,  mix  thoroughly  and  do  not  store.

Sodium Bicarbonate  Injection, USP is  a sterile, nonpyrogenic, hypertonic  solution of  sodium  bicarbonate (NaHCO3) in water for injection for administration by the intravenous route as an  electrolyte  replenisher  and  systemic  alkalizer.

Solutions  are   offered  in  concentration  of  8.4%.  See  table  in HOW  SUPPLIED section  for  contents  and  characteristics.

The  solutions  contain no  bacteriostat, antimicrobial  agent or  added buffer  and are  intended only for  use  as  a single-dose  injection, the  approximate  pH of  the  solutions  is  8. When smaller  doses  are  required,  the  unused  portion  should  be  discarded.

Sodium bicarbonate, 84  mg  is  equal  to  one  milliequivalent each of  Na+  and HCO3-. Sodium Bicarbonate,  USP  is  chemically  designated  NaHCO3,  a  white  crystalline  powder  soluble  in  water.

Water  for  Injection is  chemically  designated  H2O.

Intravenous sodium bicarbonate therapy increases plasma bicarbonate, buffers excess hydrogen ion concentration, raises blood pH and reverses the clinical manifestations of acidosis. Sodium bicarbonate in water dissociates to provide sodium (Na ⁺ ) and bicarbonate (HCO ₃ ^- ) ions. Sodium (Na ⁺ ) is the principal cation of the extracellular fluid and plays a large part in the therapy of fluid and electrolyte disturbances. Bicarbonate (HCO ₃ ^- ) is a normal constituent of body fluids and the normal plasma level ranges from 24 to 31 mEq/liter. Plasma concentration is regulated by the kidney through acidification of the urine when there is a deficit or by alkalinization of the urine when there is an excess. Bicarbonate anion is considered "labile" since at a proper concentration of hydrogen ion (H ⁺ ) it may be converted to carbonic acid (H ₂ CO ₃ ) and thence to its volatile form, carbon dioxide (CO ₂ ) excreted by the lung. Normally a ratio of 1:20 (carbonic acid: bicarbonate) is present in the extracellular fluid. In a healthy adult with normal kidney function, practically all the glomerular filtered bicarbonate ion is reabsorbed; less than 1% is excreted in the urine.

Sodium  Bicarbonate  Injection, USP  is  supplied  in  the  following  dosage forms:

The 50  mL Sodium Bicarbonate Injection vials are supplied as 25  vials per carton with a single package  insert.

Exposure  of pharmaceutical products to  heat should be  minimized. Avoid excessive  heat. Protect from  freezing.  Store  at  20°C  to  25°C  (68°F  to  77°F).  [See  USP  Controlled  Room  Temperature].

Manufactured  by :

Steriscience Sp. z o.o.

No. 10, Daniszewska Street,

Warsaw, Poland – 03-230

Distributed by:
Sun Pharmaceutical Industries, Inc.

Cranbury, NJ 08512

Revised: November 2023