Sodium Bicarbonate
Sodium Bicarbonate is a systemic and urinary alkalinizer.
Group
Systemic and urinary alkalinizer
Mechanism of Action
Supplies bicarbonate to buffer hydrogen ions and increases urinary alkalinity.
Dose Rates
Dogs
| Use / stage | Dose | Route | Schedule | Instructions |
|---|---|---|---|---|
| Metabolic acidosis | 0.5–1 mEq/kg | IV | Individualize from measured acid-base status. | |
| Urinary alkalinization | 50 mg/kg | PO | Every 8–12 h | |
| Oral antacid | 2–5 g/animal | PO | Mix with water; other agents suppress acid more effectively. | |
| Cardiopulmonary resuscitation — Initial | 1 mEq/kg | IV | Once | |
| Cardiopulmonary resuscitation — Maintenance | 0.5 mEq/kg | IV | Every 0.1666666667 h | Additional doses every 10 minutes in the reported guidance; use only when clinically indicated. |
| Severe uremic metabolic acidosis | 1–2 mEq/kg | IV | Slow administration when severe acidemia is suspected and blood gases unavailable; treat cause and reassess after buffering/distribution. | |
| Hyperkalemic crisis adjunct | 1–2 mEq/kg | IV | Slow administration; ventilation and electrolyte monitoring required. | |
| Hyperkalemic crisis with impaired perfusion | 2–3 mEq/kg | IV | Over 30 minutes in a reported non-DKA rescue protocol; individualize. | |
| Urate urolith alkalinization | 0.1–0.2 g/kg | PO | Every 8 h | Equivalent to 0.5-1 g per 5 kg; titrate urine pH around 7-7.5. |
Cats
| Use / stage | Dose | Route | Schedule | Instructions |
|---|---|---|---|---|
| Metabolic acidosis | 0.5–1 mEq/kg | IV | Individualize from measured acid-base status. | |
| Urinary alkalinization | 50 mg/kg | PO | Every 8–12 h | |
| Oral antacid | 2–5 g/animal | PO | Mix with water; other agents suppress acid more effectively. | |
| Cardiopulmonary resuscitation — Initial | 1 mEq/kg | IV | Once | |
| Cardiopulmonary resuscitation — Maintenance | 0.5 mEq/kg | IV | Every 0.1666666667 h | Additional doses every 10 minutes in the reported guidance; use only when clinically indicated. |
| Severe uremic metabolic acidosis | 1–2 mEq/kg | IV | Slow administration when severe acidemia is suspected and blood gases unavailable; treat cause and reassess after buffering/distribution. | |
| Hyperkalemic crisis adjunct | 1–2 mEq/kg | IV | Slow administration; ventilation and electrolyte monitoring required. | |
| Hyperkalemic crisis with impaired perfusion | 2–3 mEq/kg | IV | Over 30 minutes in a reported non-DKA rescue protocol; individualize. |
Large_animals
| Use / stage | Dose | Route | Schedule | Instructions |
|---|---|---|---|---|
| Metabolic acidosis | 0.5–1 mEq/kg | IV | Slow administration; subsequent amounts based on base deficit. |
Horses
| Use / stage | Dose | Route | Schedule | Instructions |
|---|---|---|---|---|
| Oral alkalinization | 10–12 g/animal | PO | Adult animals. | |
| Oral alkalinization | 2–5 g/animal | PO | Foals, calves or pigs, respectively. |
Cattle
| Use / stage | Dose | Route | Schedule | Instructions |
|---|---|---|---|---|
| Oral alkalinization | 10–12 g/animal | PO | Adult animals. | |
| Oral alkalinization | 2–5 g/animal | PO | Foals, calves or pigs, respectively. |
Pigs
| Use / stage | Dose | Route | Schedule | Instructions |
|---|---|---|---|---|
| Oral alkalinization | 2–5 g/animal | PO | Foals, calves or pigs, respectively. |
Indications
- Selected metabolic acidosis
- Urinary alkalinization
- Selected resuscitation protocols
- Severe uremic metabolic acidosis
- Hyperkalemic crisis adjunct
- Hyperkalemic crisis with impaired perfusion
- Urate urolith alkalinization
Contraindications
- Alkalosis
- Hypocalcemia
- Excessive chloride loss from vomiting
Interactions
- Incompatible with calcium-containing fluids and many acidic/HCl drugs; oral doses can alter other drug absorption.
Adverse effects
- Hypernatremia, hyperosmolality, hypokalemia and paradoxical intracellular/CNS acidosis.
Toxicity
Excess or rapid administration can cause alkalosis, tetany, sodium/osmotic loading and electrolyte shifts. Stop supplementation and treat measured acid-base/electrolyte abnormalities.
Preparations
| Preparation | Form | Strength | Route |
|---|---|---|---|
| Sodium Bicarbonate 325 mg | Tablet | 325 mg / tablet | PO |
| Sodium Bicarbonate 520 mg | Tablet | 520 mg / tablet | PO |
| Sodium Bicarbonate 650 mg | Tablet | 650 mg / tablet | PO |
| Sodium bicarbonate 4.2% injection Amount expressed as bicarbonate equivalent. | Injection | 0.5 mEq / mL | IV |
| Sodium bicarbonate 8.4% injection Amount expressed as bicarbonate equivalent. | Injection | 1 mEq / mL | IV |
Monitoring and Administration
Use blood gases and base deficit to guide replacement: mEq requirement = kg x base deficit x 0.3, or factor 0.5 for calves/neonates. Give 25-50% initially over 20-30 minutes and reassess.
Ensure ventilation and monitor sodium, potassium and acid-base status; do not directly mix with calcium-containing fluid.
Additional deficit calculation: 0.5 x kg x (desired minus measured total CO2); give half over 3-4 hours then reassess. DKA example: kg x 0.4 x (12 minus measured bicarbonate) x 0.5 over 6 hours when bicarbonate is 11 mEq/L or less. DKA bicarbonate benefit is controversial; risks include hypokalemia, oxygen-unloading impairment and CNS acidosis. Do not administer during inadequately ventilated CPR.
Ruminant total replacement report is 2-5 mEq/kg over 4-8 hours, not that amount each hour. Severe acidotic calves have received isotonic 156 mEq/L fluid, often 2 L over 1-2 hours followed by further individualized replacement. Formula, hydration and infusion volume must be considered together.
Protect sodium bicarbonate powder from moisture and injection from freezing.