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Drug Information Request

Corrective NaHCO3 Therapy
DIR
Clinical Question

What are the indications, dosing calculation, and administration guidelines for corrective Sodium Bicarbonate (NaHCO3) therapy in metabolic acidosis?

Short Answer
Only treat if pH <= 7.20, Hyperkalemia, or severe AKI. Avoid in DKA unless pH < 6.9. Calculate deficit and replace 50% over 3-4 hours initially.

Indications for Use

Scenario Status
Severe Metabolic Acidosis
pH <= 7.20 (esp. if HCO3 < 10)		 Yes
Hyperkalemia / AKI
Adjunctive therapy		 Yes
Lactic Acidosis
Only if pH < 7.0 + shock		 Caution
Diabetic Ketoacidosis (DKA) No

Dosing Calculation

Dose (mEq) = 0.5 × Weight (kg) × (Target - Actual HCO3)
Target HCO3: 20-22 mEq/L • Use 0.3 factor for elderly
  • Example: 70kg patient, HCO3 10 mEq/L.
    0.5 × 70 × (22 - 10) = 420 mEq total deficit.
  • Initial Plan: Give 50% (210 mEq) over 3-4 hours, then recheck ABG.

Administration & Safety

  • Dilution: NaHCO3 8.4% (1 mEq/mL) in D5W or NS.
  • Standard Rate: 50–150 mEq over 2–4 hours.
  • Severe Rate: 90–180 mEq in 1L D5W at 1–1.5 L/hr.
  • Critical: Do NOT mix with Calcium (precipitates). Avoid overcorrection.
Sources: Jaber S. BICAR-ICU Trial (2018) • ADA Guidelines DKA (2024) • StatPearls (2024)
Answered by: Dr. Ahmed Khaled