“Prompt infusion of hypertonic saline may save lives and preparing a 3% hypertonic saline infusion takes time. In addition, errors may occur from having to calculate the required amount of sodium chloride in an emergency.”
– European hyponatremia guidelines 2014
Understanding 8.4% sodium bicarbonate
Dose for symptomatic hyponatremia
Evidence regarding the increase in sodium following 8.4% sodium bicarbonate
Dose for ICP elevation
Evidence regarding 8.4% sodium bicarbonate use in elevated intracranial pressure
Safety & Contraindications
Safety of sodium bicarbonate
Over-correction of hyponatremia
- 8.4% sodium bicarbonate has about the same osmolarity as 6% NaCl, making it about twice as powerful as 3% NaCl.
- For severe symptomatic hyponatremia (e.g. seizures or coma), initial treatment with 2 ml/kg of 8.4% sodium bicarbonate is reasonable. For less dire indications, ~1.5 ml/kg of 8.4% sodium bicarbonate may be used initially (which will often be about 100ml, or two 50-ml ampules).
- For elevated intracranial pressure, 80-120 ml of 8.4% sodium bicarbonate is a reasonable initial dose (e.g. two 50-ml ampules).