Sodium Bicarbonate Antidote

Sodium Bicarbonate is a prescription antidote used for reversing cocaine, cyanide, salicylate, a tricyclic antidepressant, and barbiturate toxicity and also to treat cardiac arrest. 

• Sodium Bicarbonate is available under various brand names:

Adult dosage

IV solution

• 4%
• 4.2%
• 7.5%
• 8.4%

Cocaine Toxicity

Adult dosage

• 1-2 mEq /kg IV push bolus

Cyanide Toxicity

Adult dosage

• 1-2 mEq/ kg IV push bolus

Salicylate Toxicity

Adult dosage

• 100-150 mEq IV with 40-80 mEq of potassium chloride in each liter of D5W; administer at 150-250 mL/hr to maintain higher than normal urine output

Barbiturate toxicity

Adult dosage

• 1 mEq/ kg IV bolus, followed by an IV drip of 1000 mL of D5W to which 2-3 ampules of sodium Bicarbonate are added, initiate drip rate at 200 mL/hr, titrate drip rate to blood pH (7.45) and urinary pH (7.5-8)

Cardiac Arrest

Adult dosage

• Initial: 1 mEq /kg/dose IV push bolus
• Maintenance: 0.5 mEq/kg/dose q10min or as indicated by arterial blood gases

Tricyclic Antidepressant Toxicity

Adult dosage

• Initial bolus: 1-2 mEq /kg IV push over 1-2 minutes; not to exceed 100 mEq/dose
• Follow-up infusion: 100-150 mEq in 1 L D5/0.45% NaCl infused 100-200 mL/hr IV; titrate infusion to achieve blood pH of 7.45-7.55

Metabolic Acidosis

Pediatric dosage

• Dosage based on blood gases and pH measurements (if available)
• If the acid-base status is unavailable, older children may receive 2-5 mEq/kg IV infusion over 4-8 hr; titrate infusion rate to maintain pH of 6-7

Dosage Considerations – Should be Given as Follows: 

• See “Dosages”

Common side effects of Sodium Bicarbonate include:

• fever,
• infection at the site of injection,
• blood clots in the veins (phlebitis),
• fluid leakage from the injection site, and
• fluid overload (hypervolemia).

Serious side effects of Sodium Bicarbonate include:

• dizziness,
• muscle aches or spasms,
• mood changes,
• confusion,
• irritability,
• memory problems,
• vomiting,
• weakness, and
• little or no urination.

Rare side effects of Sodium Bicarbonate include:

• none

Seek medical care or call 911 at once if you have the following serious side effects:

• Severe headache, confusion, slurred speech, arm or leg weakness, trouble walking, loss of coordination, feeling unsteady, very stiff muscles, high fever, profuse sweating, or tremors;
• Serious eye symptoms such as sudden vision loss, blurred vision, tunnel vision, eye pain or swelling, or seeing halos around lights;
• Serious heart symptoms such as fast, irregular, or pounding heartbeats; fluttering in the chest; shortness of breath; sudden dizziness, lightheartedness, or passing out.

This is not a complete list of side effects and other serious side effects or health problems that may occur because of the use of this drug. Call your doctor for medical advice about serious side effects or adverse reactions. You may report side effects or health problems to FDA at 1-800-FDA-1088.

If your medical doctor is using this medicine to treat your pain, your doctor or pharmacist may already be aware of any possible drug interactions and may be monitoring you for them. Do not start, stop, or change the dosage of any medicine before checking with your doctor, health care provider, or pharmacist first.

• Sodium Bicarbonate has no noted severe interactions with any other drugs.
• Sodium Bicarbonate has no noted serious interactions with any other drugs.
• Sodium Bicarbonate has no noted moderate interactions with any other drugs.
• Sodium Bicarbonate has no noted minor interactions with any other drugs.

This information does not contain all possible interactions or adverse effects. Visit the RxList Drug Interaction Checker for any drug interactions. Therefore, before using this product, tell your doctor or pharmacist about all your products. Keep a list of all your medications with you and share this information with your doctor and pharmacist. Check with your health care professional or doctor for additional medical advice, or if you have health questions or concerns.

Contraindications

None

Effects of drug abuse

None

Short-Term Effects

• See “What Are Side Effects Associated with Using Sodium Bicarbonate?”

Long-Term Effects

• See “What Are Side Effects Associated with Using Sodium Bicarbonate?”

Cautions

• None

Pregnancy & Lactation

• Use with caution if benefits outweigh risks during pregnancy
• Lactation
  • None