Bicarb (Sodium Bicarbonate (NaHCO₃))
Also sold as: Bicarb (Cipla), Sodium Bicarbonate Injection, Alkasol (Sodium Citrate combination), Bicarb tablets (various)
Pregnancy
Cat C
Lactation
Safe
Schedule
H
Forms
Tablet 500mg (oral) +3
Indications
- Metabolic acidosis (severe — pH < 7.1; renal tubular acidosis — ongoing bicarbonate wasting)
- CKD-related metabolic acidosis (oral supplementation — delays CKD progression)
- Urinary alkalinisation (for uric acid stones, salicylate poisoning, methotrexate clearance)
- Cardiac arrest resuscitation (hyperkalemia, tricyclic antidepressant overdose — IV)
- Sodium channel blocker toxicity (TCA overdose — causes QRS widening → IV NaHCO₃ narrows QRS)
Adult Dosing
CKD metabolic acidosis (oral maintenance)
500–1000 mg PO BD–TDS (titrate to maintain serum bicarbonate 22–26 mEq/L)
KDIGO target: maintain HCO₃ > 22 mEq/L in CKD — slows kidney disease progression.
Metabolic acidosis (IV acute)
Calculated dose: Base deficit (mEq) = 0.3 × weight (kg) × (target HCO₃ − current HCO₃). Give half the deficit over 30 min, reassess. Typical: 50–100 mEq (50–100 mL of 8.4%) IV over 30–60 min.
Correct underlying cause. Do NOT overshoot — alkalosis is harmful.
Urinary alkalinisation (uric acid stones)
1–2g PO TDS (titrate to urine pH 6.5–7.0 — test with litmus/pH strips)
TCA overdose (IV)
1–2 mEq/kg IV bolus; repeat until QRS narrows and arrhythmias resolve. Target blood pH 7.50–7.55.
Life-saving in TCA toxicity — IV bolus 50 mEq every 3–5 min in cardiac arrest
Pediatric Dosing
Neonates: always dilute 8.4% 1:1 with sterile water to make 4.2% before giving IV. Rapid IV in premature infants: intraventricular haemorrhage risk.
Renal Dose Adjustment
| CrCl / eGFR | Dose Adjustment |
|---|---|
| CKD | Primary indication in CKD — dose titrated to maintain bicarbonate 22–26 mEq/L. Monitor sodium (sodium load with high doses). |
Hepatic Adjustment
No dose adjustment required
Pregnancy & Lactation
Pregnancy: Category C
Sodium bicarbonate is used in acute resuscitation (cardiac arrest) in pregnancy without restriction. Oral use for metabolic acidosis in pregnancy (CKD): acceptable. Avoid excessive sodium loading (pre-eclampsia risk — fluid retention).
Lactation: Safe
Oral supplementation: safe in breastfeeding. Sodium bicarbonate is a normal body constituent.
Top Drug Interactions
| Interacting Drug | Effect | Severity |
|---|---|---|
| Amphetamines, ephedrine, pseudoephedrine | Alkaline urine reduces renal elimination of these drugs — elevated levels, toxicity | Moderate |
| Tetracyclines, fluoroquinolones | Alkaline environment reduces absorption of these antibiotics — separate by 2 hours | Moderate |
| Lithium | Alkaline urine increases lithium excretion — may reduce lithium levels unexpectedly | Moderate |
| Methotrexate | Urinary alkalinisation (therapeutic intent) increases MTX renal clearance — used in high-dose MTX protocols to reduce toxicity | Minor |
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Side Effects
Common
- Belching (CO₂ release — oral)
- Bloating and flatulence (oral)
- Metabolic alkalosis (over-treatment — nausea, tetany, seizures)
- Hyponatraemia or hypernatraemia (sodium load)
- Hypokalaemia (alkalosis shifts K⁺ intracellularly)
Serious / Discontinue If
- Metabolic alkalosis (dangerous — tetany, arrhythmias, respiratory depression)
- Hyperosmolarity (IV 8.4% — especially in neonates: IVH)
- Fluid overload (sodium load — especially in heart failure, CKD)
- Paradoxical intracellular acidosis (IV — CO₂ generation crosses cell membranes faster than HCO₃⁻)
- Tissue necrosis (IV extravasation — highly alkaline solution)
Contraindications
- Metabolic alkalosis (giving NaHCO₃ worsens alkalosis)
- Severe volume overload or heart failure (sodium load)
- Hypocalcaemia (alkalosis precipitates tetany)
- Use in lactic acidosis (controversial — may worsen)
Available Indian Brands
| Brand | Manufacturer | Price (approx) |
|---|---|---|
| Sodium Bicarbonate 8.4% Injection 50mL | Baxter/Neon Labs | Vial ₹35 |
| NaHCO₃ 500mg tablet | Various generic | 100 tab ₹45 |
Monitoring Required
- Arterial blood gas (ABG) — pH, pCO₂, bicarbonate (IV use)
- Serum electrolytes (sodium, potassium, chloride)
- Urine pH (alkalinisation — target 6.5–7.0 for uric acid stones)
- Serum osmolality (high-dose IV)
- ECG (TCA overdose — QRS width monitoring)
Patient Counseling Points
- Oral tablets (CKD): take with meals — reduces belching and stomach discomfort
- Belching after taking is common — the CO₂ released from acid neutralisation is harmless
- Do not take within 2 hours of antibiotics (ciprofloxacin, doxycycline) or other medications — reduces their absorption
- For urine alkalinisation (kidney stones): check urine pH with strips — target slightly alkaline (6.5–7.0)
- Report swollen ankles, breathlessness, or sudden confusion — signs of excessive sodium/fluid
- Regular blood tests are important when on long-term bicarbonate — to keep levels in the right range
Stop Googling drug references mid-consultation
EasyClinic auto-flags Bicarb interactions, renal cutoffs, and pregnancy warnings the moment you write the prescription. Built-in safety net for every Indian doctor.
Clinically reviewed by: Dr. Anand Prabhakar, DM (Nephrology), Consultant Nephrologist
Last reviewed: 2026-04-01
References
- KDIGO CKD Metabolic Acidosis Guidelines 2020
- BNF — Sodium Bicarbonate
- ACLS TCA Overdose Protocol
- NICE CKD Guidelines
- Indian Society of Nephrology — Acid-Base Management