Sodium bicarbonate
8.4% bicarbonate 50–100 mL IV for tricyclic overdose with a wide QRS. Not routine in DKA or cardiac arrest.
On this page
Dose
| Indication | Dose |
|---|---|
| Tricyclic overdose with wide QRS or arrhythmia | 50–100 mL of 8.4% (1 mmol/mL) IV, repeat to keep pH 7.45–7.55 (poison centre advice) |
| Salicylate poisoning (urinary alkalinisation) | 1.26% or 8.4% per poison centre protocol |
| Severe metabolic acidosis (selected) | Specialist or ICU decision |
Cautions
- Not routine in DKA or cardiac arrest.
- Causes high sodium, low potassium, fluid overload; tissue damage if it leaks.
- Don't mix with calcium in the same line.
Frequently asked questions
When is sodium bicarbonate given in overdose?
Mainly in tricyclic antidepressant overdose with a wide QRS, arrhythmias or low BP.
Used in these guides
Sources
Doses on this page are typical doses from the sources above. Always confirm with a current drug reference, the product leaflet and your hospital protocol, especially in children, pregnancy and kidney or liver disease.
For FCPS Part 1
Revising for FCPS Part 1? Sodium bicarbonate is covered in our textbook chapter Adverse drug reactions, with practice MCQs.