Sodium Bicarbonate Drip

Reasons for needing a sodium bicarbonate (bicarb) drip are discussed in excellent posts by Pulm Crit and LITFL. One can be made by mixing the following:

Mixing

  • 1 liter D5W, remove 150 ml from bag 
  • 3 ampules of 8.4% NaHCO3 (50 mEq each in 50 ml), inject each into the D5W bag

Indication

  • Mixing the infusion above yields 150 mEq/L at 300 mOsmol, which is slightly higher than serum concentrations. 
  • Infuse 1 liter @ 200 ml/hr (urine alkalinization) up 1 L/hr (cardiac arrest with poor pressors response), depending on indication. 

Further Reading

Acid-Base Disturbances: An Emergency Department Approach Date Release: Jun 2020 Acid-base disturbances signal many disorders and diseases, and interpretation of testing results can be difficult. Using descriptive methodologies, comparing various approaches, and following a diagnostic algorithm will improve diagnosis and treatment.

Calcium Channel Blocker and Beta Blocker Overdose, and Digoxin Toxicity Management – Pharmacology EXTRA Supplement (Pharmacology CME) Date Release: Sep 2020 This Pharmacology EXTRA CME supplement (free to Emergency Medicine Practice subscribers) provides an evidence-based overview of emergency department management of calcium-channel blocker overdose, beta blocker overdose, and digoxin toxicity, and focuses on the caveats of treatment for each.

References

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