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Sodium Bicarbonate (Antidote)

    DEA Class; Rx

    Common Brand Names; 

    • Antidotes, Other

    Increases blood and urinary pH by releasing a bicarbonate ion, which in turn neutralizes hydrogen ion concentrations

    1g of sodium bicarbonate is equivalent to 11.9 mEq each of sodium and bicarbonate

    Indicated for

    • Cocaine Toxicity
    • Cyanide Toxicity
    • Salicylate Toxicity
    • Barbiturate Toxicity
    • Cardiac Arrest
    • Tricyclic Antidepressant Toxicity

    Other Indications & Uses

    All Class 1 antidysryhthmics (quinidine, procainamide, encainide, flecainide; cardiac conduction defect)

    Antihistamines (H1 blockers & nonsedating varieties)


    Ethylene glycol, methanol

    Na+ channel blocking drugs in general

    Salicylates, phenobarbital, chlorpropamide (see Urinary Alkalinization)




    Gastric distension



    Milk-alkali syndrome

    Pulmonary edema

    Pregnancy Category: C


    Cocaine Toxicity

    1-2 mEq/kg IV push bolus

    Cyanide Toxicity

    1-2 mEq/kg IV push bolus

    Salicylate Toxicity

    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

    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

    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

    Use if QRS >100-200 ms or hypotension

    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


    If acid-base status unavailable, older children may receive 2-5 mEq/kg IV infusion over 4-8 hr; titrate infusion rate to maintain pH of 6-7

    Sodium bicarbonate (Antidote)

    IV solution

    • 4%
    • 4.2%
    • 7.5%
    • 8.4%