Adult: Severe cases (e.g. cardiac arrest): 1 mmol/kg, followed by 0.5 mmol/kg given at 10-minute intervals based on the arterial blood gases. Doses are given via slow IV infusion. Less urgent cases: 2-5 mmol/kg via IV infusion given over 4-8 hours. Subsequent doses must be adjusted based on the patient's requirements. The volume, strength, and rate of infusion depend on the requirements of individual patients. Dosage and treatment recommendations may vary among countries and individual products (refer to specific product and country guidelines). Child: Severe cases: 1 mmol/kg via slow IV infusion. The volume, strength, and rate of infusion depend on the requirements of individual patients. Dosage and treatment recommendations may vary among countries and individual products (refer to specific product and country guidelines).
Oral Metabolic acidosis
Adult: Dosage is individualised according to the severity of the metabolic acidosis, results of blood gas analysis or determination of sodium bicarbonate. For the treatment of cases in patients with chronic renal impairment: 3,000-5,000 g daily in divided doses. Dosage and treatment recommendations may vary among countries and individual products (refer to specific product guidelines).
Oral Antacid
Adult: For the relief of dyspepsia, heartburn, hyperacidity, and upset stomach associated with these symptoms: As tab or oral solution: 650-2,600 mg 4 hourly. Max: 15,600 mg daily. Alternatively, 1,000-5,000 mg may be given as necessary. As powder for oral solution : 2,616 mg (1/2 teaspoon) dissolved in 4 ounces of water; may be given 2 hourly as necessary. Max: 15,600 mg daily. Avoid using the Max dose for >2 weeks. Dosage and treatment recommendations may vary among countries and individual products (refer to specific product guidelines). Child: ≥6 years For the relief of dyspepsia, heartburn, hyperacidity and upset stomach associated with these symptoms: As powder for oral solution: 2,616 mg (1/2 teaspoon) 2 hourly as necessary. Max: 15,600 mg daily. Avoid using the Max dose for >2 weeks. Dosage and treatment recommendations may vary among countries and individual products (refer to specific product guidelines).
What are the brands available for Sodium bicarbonate in Malaysia?
Sodium bicarbonate May be taken with or without food.
Reconstitution
Powder for oral solution: Dissolve 1/2 teaspoonful completely in 4 ounces of water. Neonate to children <2 years of age: IV infusion for severe cases of metabolic acidosis: Dilute the sodium bicarbonate 8.4% solution with an equal amount (1:1 ratio) of dextrose 5% in water or water for inj to make a sodium bicarbonate 4.2% solution. Adult: IV infusion for less urgent cases of metabolic acidosis: May dilute sodium bicarbonate 8.4% with dextrose 5% in water or NaCl 0.9%.
Incompatibility
IV: Incompatible with ascorbic acid, epinephrine, benzylpenicillin, Mg salts, carmustine, cisplatin, codeine, corticotropin, dobutamine, insulin, labetalol, levorphanol, methadone, morphine, norepinephrine, oxytetracycline, pethidine, pentobarbitone, procaine, streptomycin, suxamethonium, tetracycline, vancomycin, vitamin B complex, and lactated Ringer's solution. Precipitation may occur with parenteral solutions containing Ca.
Contraindications
Metabolic or respiratory alkalosis, hypokalaemia, hypernatraemia, hypocalcaemia, hypochlorhydria. IV: Chloride loss due to vomiting or continuous gastrointestinal suction. Concomitant use with diuretics known to cause hypochloraemic alkalosis.
Special Precautions
Patient with CHF, hypertension, oedema, cirrhosis; eclampsia, aldosteronism, or other conditions associated with sodium retention. Avoid extravasation (IV). Not indicated for the treatment of peptic ulcer disease. Not for use in patients on low sodium diets. Renal and hepatic impairment. Elderly. Pregnancy and lactation.
Adverse Reactions
Significant: Sodium retention; alkalosis (excess or prolonged use). IV: Tissue necrosis (following extravasation), metabolic alkalosis, hypernatraemia, hypokalaemia, fluid and/or solute overload leading to overhydration, congested states or pulmonary oedema; decreased CSF pressure and possible intracranial haemorrhage (rapid IV administration in neonates and children <2 years). Gastrointestinal disorders: Stomach pain, flatulence. Investigations: Increased blood pressure. Metabolism and nutrition disorders: Fluid retention. Musculoskeletal and connective tissue disorders: Tetany. Nervous system disorders: Headache. Psychiatric disorders: Nervousness, restlessness, hyperirritability.
Hemodialysis/IV/Parenteral/PO: Z (May cause adverse effects (e.g. metabolic alkalosis, fluid overload) in mother and foetus. Consult product literature or clinical guidelines for specific recommendations.)
Monitoring Parameters
Monitor serum electrolytes (e.g. sodium, K, Ca, bicarbonate), urinary PH; arterial blood gases (as necessary); infusion site for patency.
Overdosage
Symptoms: Hypokalaemia and metabolic alkalosis (particularly if renal function is impaired). In severe cases, irregular heartbeat, mood changes, shortness of breath, tiredness, muscle weakness, convulsions, and coma. Muscle hypertonicity, twitching, and tetany may also occur particularly in hypocalcaemic patients; sodium overload, hyperosmolality. Management: Supportive treatment. Rebreathe expired air to control symptoms of alkalosis. Correct fluid and electrolyte imbalance. May administer potassium chloride for hypokalaemia. May give 0.9% NaCl. In severe alkalosis, give IV ammonium chloride (except in patients with pre-existing hepatic disease) and/or Ca gluconate.
Drug Interactions
Increased excretion of lithium, aspirin, and methotrexate. Reduced excretion of ephedrine and quinidine. Decreased absorption of antibacterials (e.g. tetracycline, rifampicin) and antifungals (e.g. itraconazole, ketoconazole), dipyridamole, phenothiazines, chloroquine, hydroxychloroquine, phenytoin, gabapentin, bisphosphonates, penicillamine, captopril, enalapril. May cause hypochloraemic alkalosis with K-depleting diuretics (e.g. furosemide, bumetanide, etacrynic acid, and thiazides).
Action
Description: Mechanism of Action: Sodium bicarbonate is a systemic alkalinising agent. It dissociates to provide bicarbonate ion, which neutralises the hydrogen ion concentration, raises blood and urinary pH, and reverses the clinical manifestations of metabolic acidosis. Onset: 15 minutes (oral); rapid (IV). Duration: 1-3 hours (oral); 8-10 minutes (IV). Pharmacokinetics: Absorption: Rapidly absorbed from the gastrointestinal tract. Distribution: Present in all body fluids. Metabolism: Not significantly metabolised. Excretion: Via urine (<1%).
Chemical Structure
Sodium bicarbonate Source: National Center for Biotechnology Information. PubChem Compound Summary for CID 516892, Sodium Bicarbonate. https://pubchem.ncbi.nlm.nih.gov/compound/Sodium-Bicarbonate. Accessed Mar. 27, 2025.
Storage
Store below 30°C. Do not freeze the solution for infusion. Diluted IV solution for infusion: Store between 2-8°C for ≤24 hours.
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