Natriumbikarbonat Fresenius Kabi (Sodium Bicarbonate)
Alkalinizing agent for metabolic acidosis and cardiac arrest
Quick Facts: Sodium Bicarbonate
Key Takeaways: What You Need to Know
- Hospital medication: Sodium bicarbonate IV is administered by healthcare professionals in clinical settings, not for self-administration at home
- Corrects blood acidity: Works by providing bicarbonate ions that neutralize excess acid in the blood, restoring normal pH balance
- Critical in cardiac arrest: Used as part of advanced cardiac life support (ACLS) protocols when acidosis is confirmed or suspected
- Monitor blood gases: Arterial blood gas analysis is essential before and during administration to guide dosing and prevent overcorrection
- Contraindicated in respiratory failure: Must not be used in patients with respiratory insufficiency and elevated CO₂ levels, as it generates carbon dioxide during buffering
What Is Natriumbikarbonat Fresenius Kabi and What Is It Used For?
Natriumbikarbonat Fresenius Kabi is an intravenous sodium bicarbonate solution that counteracts dangerous acidification of the blood (metabolic acidosis). It is a prescription-only medication most commonly administered in emergency departments and intensive care units during conditions such as cardiac arrest, severe sepsis, and diabetic ketoacidosis.
Sodium bicarbonate (chemical formula NaHCO₃) is one of the most widely used alkalinizing agents in modern medicine. When dissolved in the bloodstream, it dissociates into sodium ions (Na⁺) and bicarbonate ions (HCO₃⁻). The bicarbonate ions directly neutralize excess hydrogen ions (H⁺) that cause the blood to become acidic, a condition known as metabolic acidosis. This chemical reaction produces water (H₂O) and carbon dioxide (CO₂), the latter of which is eliminated through the lungs during normal respiration.
Metabolic acidosis is a potentially life-threatening condition that can arise from numerous causes. During cardiac arrest, for instance, inadequate blood circulation leads to anaerobic metabolism in tissues, generating lactic acid that rapidly lowers blood pH. Similarly, in severe diabetic ketoacidosis (DKA), the body produces ketone bodies that acidify the blood. Renal failure, septic shock, and certain drug overdoses can also precipitate dangerous levels of acidosis that require immediate correction.
The Fresenius Kabi formulation is available primarily as a 50 mg/mL solution for intravenous infusion, supplied in 100 mL glass bottles. An oral tablet formulation (1 g) also exists for conditions requiring longer-term oral alkalinization, such as chronic metabolic acidosis associated with renal tubular acidosis or for urinary alkalinization in certain clinical situations.
Sodium bicarbonate infusion is a hospital-administered medication. It requires careful monitoring of arterial blood gases and electrolytes during administration. The dose is always individualized based on the patient's specific acid-base status and underlying condition. Never attempt to use intravenous sodium bicarbonate without proper medical supervision.
Mechanism of Action
The therapeutic effect of sodium bicarbonate relies on a straightforward acid-base chemistry principle. When bicarbonate ions enter the bloodstream, they act as a buffer against excess hydrogen ions according to the reaction: HCO₃⁻ + H⁺ → H₂CO₃ → H₂O + CO₂. This reaction effectively removes acidic hydrogen ions from the blood, raising the pH toward normal levels (7.35–7.45).
However, it is crucial to understand that this buffering process generates carbon dioxide as a byproduct. In patients with adequate respiratory function, this CO₂ is readily eliminated through increased ventilation. In patients with compromised lung function or during cardiac arrest with poor ventilation, the accumulated CO₂ can paradoxically worsen intracellular acidosis, which is why careful patient selection and monitoring are essential.
Clinical Indications
The primary clinical indications for intravenous sodium bicarbonate include:
- Cardiac arrest: Administered when metabolic acidosis is confirmed (pH < 7.1) or after prolonged resuscitation efforts, as per European Resuscitation Council (ERC) and American Heart Association (AHA) guidelines
- Severe metabolic acidosis: When blood pH falls below 7.1–7.15, regardless of the underlying cause
- Tricyclic antidepressant overdose: Sodium bicarbonate is first-line treatment for cardiotoxicity from tricyclic antidepressant poisoning, where it helps normalize cardiac conduction
- Hyperkalemia: Used as an adjunct treatment to shift potassium back into cells by alkalinizing the blood
- Salicylate poisoning: Urinary alkalinization with sodium bicarbonate enhances renal excretion of salicylates
- Renal tubular acidosis: Chronic oral supplementation to correct ongoing bicarbonate losses
What Should You Know Before Receiving Sodium Bicarbonate?
Sodium bicarbonate must not be used in patients with respiratory insufficiency with elevated arterial CO₂ pressure (above 6.5–7 kPa) or in those with known allergy to the substance. Special caution is required in patients with impaired heart or kidney function and in those receiving insulin therapy for diabetes.
Before sodium bicarbonate is administered, your healthcare team will assess several important factors to ensure the medication is safe and appropriate for your specific situation. This assessment typically involves reviewing your medical history, current medications, and performing blood gas analysis to determine the severity and type of acidosis present.
Contraindications
Sodium bicarbonate is contraindicated (must not be given) in the following situations:
- Known allergy to sodium bicarbonate: Although extremely rare, hypersensitivity reactions to sodium bicarbonate have been reported. If you have experienced any previous allergic reaction to this substance, inform your healthcare provider immediately
- Respiratory insufficiency with elevated CO₂: In patients with respiratory failure where the arterial carbon dioxide pressure exceeds 6.5–7 kPa (approximately 49–53 mmHg), sodium bicarbonate is contraindicated. Since the buffering reaction generates CO₂ as a byproduct, administering bicarbonate to a patient who cannot adequately ventilate will worsen respiratory acidosis and may lead to clinical deterioration
- Metabolic or respiratory alkalosis: Patients who already have an alkaline blood pH should not receive additional bicarbonate, as this would exacerbate the alkalosis and can cause serious complications including cardiac arrhythmias and seizures
Warnings and Precautions
Your healthcare provider should be informed if you have any of the following conditions, as they may require dose adjustments or additional monitoring:
- Impaired cardiac function: Sodium bicarbonate contains sodium ions, and rapid infusion can cause fluid overload and exacerbate heart failure. The sodium load may be significant in patients with compromised cardiac output or those on sodium-restricted diets
- Impaired kidney function: The kidneys play a central role in bicarbonate regulation and sodium excretion. Patients with renal impairment may not be able to handle the additional sodium and bicarbonate load, increasing the risk of hypernatremia and metabolic alkalosis
- Insulin-treated diabetes: Correction of acidosis with sodium bicarbonate can cause rapid shifts in potassium from the extracellular to intracellular space, potentially causing dangerous hypokalemia (low potassium). This is particularly relevant in diabetic ketoacidosis (DKA), where potassium monitoring is critical
- Hypokalemia: Pre-existing low potassium levels may be worsened by bicarbonate administration, as alkalinization drives potassium into cells
- Hypocalcemia: Alkalosis reduces the concentration of ionized calcium in the blood, which may precipitate tetany or cardiac arrhythmias in patients with borderline calcium levels
Rapid or excessive administration of sodium bicarbonate can cause metabolic alkalosis, hypernatremia, hypokalemia, and paradoxical intracellular acidosis. Always ensure adequate ventilation during administration to allow elimination of the CO₂ produced by the buffering reaction. Arterial blood gas monitoring is mandatory.
Pregnancy and Breastfeeding
There are no known risks associated with sodium bicarbonate use during pregnancy or breastfeeding when administered at appropriate doses under medical supervision. Sodium bicarbonate is a naturally occurring substance in the body and is part of the normal bicarbonate buffering system. The European Medicines Agency (EMA) and other regulatory bodies have not identified specific reproductive toxicity concerns with this medication.
However, as with all medications during pregnancy, sodium bicarbonate should only be used when the clinical benefit clearly justifies any potential risk. Your healthcare provider will carefully evaluate the need for treatment and use the lowest effective dose for the shortest possible duration. If you are pregnant, breastfeeding, think you may be pregnant, or are planning to have a baby, always inform your healthcare team before any medication is administered.
Driving and Operating Machinery
There are no known effects of sodium bicarbonate on the ability to drive or operate machinery. However, since the intravenous formulation is administered in hospital settings during acute medical conditions, the question of driving is typically not relevant during active treatment. Patients receiving oral sodium bicarbonate tablets for chronic conditions can generally drive and operate machinery without restrictions.
How Does Sodium Bicarbonate Interact with Other Drugs?
Sodium bicarbonate can alter the absorption, distribution, and elimination of numerous medications by changing urinary pH and blood pH. It may increase the effects of some drugs (such as amphetamines and quinidine) while decreasing the effects of others (such as lithium and tetracyclines). Always inform your healthcare team of all medications you are taking.
Drug interactions with sodium bicarbonate are primarily mediated through two mechanisms: alteration of urinary pH (which affects renal excretion of drugs) and changes in gastrointestinal pH (which affects absorption of oral medications). When blood and urine become more alkaline, weakly acidic drugs are more readily excreted by the kidneys, while weakly basic drugs are retained longer in the body.
In the hospital setting, the medical team will review all concurrent medications before administering sodium bicarbonate. For patients on chronic oral bicarbonate therapy, it is essential to inform your prescriber of all other medications, including over-the-counter drugs and supplements, to avoid potentially harmful interactions.
| Drug | Effect of Interaction | Severity | Management |
|---|---|---|---|
| Lithium | Increased renal excretion, reduced lithium levels | Major | Monitor lithium levels closely; dose adjustment may be needed |
| Methotrexate | Increased renal excretion; may reduce efficacy or be used therapeutically to prevent nephrotoxicity | Moderate | Used intentionally in high-dose methotrexate protocols; monitor levels |
| Salicylates (Aspirin) | Enhanced renal elimination; used therapeutically in overdose | Moderate | Beneficial in overdose; monitor salicylate levels and urine pH |
| Tetracyclines | Reduced oral absorption due to chelation and pH changes | Moderate | Separate administration by at least 2 hours |
| Quinidine | Reduced renal excretion, increased quinidine levels | Major | Monitor quinidine levels; reduce dose if needed |
| Amphetamines | Reduced renal excretion, prolonged and enhanced effects | Major | Avoid concurrent use; monitor for amphetamine toxicity |
| Iron supplements | Reduced oral absorption due to increased gastric pH | Moderate | Separate administration by at least 2 hours |
| Ketoconazole | Reduced oral absorption (requires acidic pH for dissolution) | Major | Avoid concurrent oral use; consider alternative antifungal |
Major Interactions
The most clinically significant interactions involve drugs with narrow therapeutic indices that are sensitive to urinary pH changes. Lithium is particularly important: alkalinization of the urine significantly increases lithium clearance, potentially leading to subtherapeutic levels and relapse of bipolar disorder. Patients on lithium therapy who require sodium bicarbonate must have their lithium levels monitored frequently, with dose adjustments as needed.
Quinidine and other antiarrhythmics are also affected. Urinary alkalinization reduces quinidine excretion, leading to elevated plasma levels and increased risk of cardiac toxicity, including QT prolongation and torsades de pointes. Similarly, amphetamines and related stimulants persist longer in the body when urine is alkaline, increasing the risk of cardiovascular and central nervous system toxicity.
Minor Interactions
Less significant but still noteworthy interactions include effects on the absorption of oral medications. Sodium bicarbonate increases gastric pH when taken orally, which can reduce the absorption of drugs that require an acidic environment for dissolution. This includes iron supplements, certain azole antifungals (ketoconazole, itraconazole), and some protease inhibitors. These interactions can generally be managed by separating the administration times by at least two hours.
Enteric-coated medications may also be affected, as the increased gastric pH can cause premature dissolution of the enteric coating in the stomach rather than the intended release in the small intestine. Patients on chronic oral bicarbonate therapy should discuss the timing of all their medications with their pharmacist or physician.
What Is the Correct Dosage of Sodium Bicarbonate?
The dose of intravenous sodium bicarbonate is always individualized based on arterial blood gas analysis and the patient's clinical condition. Your physician determines the exact dose using the base deficit calculation. A common starting point in cardiac arrest is 1 mEq/kg body weight, with subsequent doses guided by repeated blood gas measurements.
Dosing sodium bicarbonate correctly is both an art and a science. Unlike many medications with fixed dosing schedules, sodium bicarbonate requires real-time assessment of the patient's acid-base status through arterial blood gas (ABG) analysis. The goal is to raise the blood pH to a safe level (typically above 7.2) without overcorrecting to alkalosis, which carries its own set of serious risks.
Adults
For adult patients, the dose is calculated based on the measured base deficit from arterial blood gas analysis using the following formula:
Standard Dosing Formula
Dose (mEq) = Base Deficit × Body Weight (kg) × 0.3
Typically, half the calculated dose is administered initially as a slow intravenous infusion. The patient is then reassessed with repeat blood gas analysis before administering any additional doses. This cautious approach prevents overcorrection and allows the medical team to evaluate the patient's response to therapy.
Cardiac Arrest Protocol
Initial dose: 1 mEq/kg (approximately 1 mL/kg of 8.4% solution)
During cardiac arrest, the initial dose is typically 1 mEq per kilogram of body weight. Subsequent doses of 0.5 mEq/kg may be administered every 10 minutes of continued arrest, ideally guided by blood gas analysis when available. The European Resuscitation Council (ERC) recommends sodium bicarbonate in cardiac arrest primarily when there is confirmed severe metabolic acidosis (pH < 7.1) or in specific situations such as tricyclic antidepressant overdose or hyperkalemia.
Severe Metabolic Acidosis
Titrated to target pH 7.2–7.25
For non-arrest metabolic acidosis, sodium bicarbonate infusion is administered slowly with careful monitoring. The rate and total dose depend on the severity of acidosis and the underlying cause. Many guidelines recommend targeting a pH of approximately 7.2 rather than complete normalization, as the body's compensatory mechanisms will often correct the remaining deficit once the underlying cause is addressed.
Children
Pediatric dosing follows the same principles as adult dosing but requires even more careful calculation due to smaller body size and different physiological reserves. The standard pediatric dose for metabolic acidosis is calculated using the same base deficit formula adjusted for the child's body weight.
In neonatal and pediatric cardiac arrest, the recommended initial dose is 1 mEq/kg administered as a slow intravenous push. For neonates, the 4.2% solution (0.5 mEq/mL) is preferred over the 8.4% solution to reduce the risk of intraventricular hemorrhage associated with the hyperosmolar concentrated solution. Rapid bolus administration should be avoided in neonates due to the risk of rapid changes in serum osmolality.
Elderly
Elderly patients often have reduced renal function and cardiac reserve, making them more susceptible to the sodium and fluid load associated with sodium bicarbonate administration. Dose adjustments are typically not based on age alone but rather on the individual patient's renal function (estimated glomerular filtration rate, eGFR) and cardiac status. Lower initial doses and slower infusion rates are generally prudent in elderly patients, with frequent monitoring of electrolytes, fluid balance, and blood gases.
Missed Dose
Since intravenous sodium bicarbonate is administered in acute hospital settings under direct medical supervision, the concept of a missed dose does not typically apply. The medication is given in response to specific laboratory findings (blood gas results) and clinical conditions, and dosing is adjusted in real time based on the patient's response. For patients on chronic oral sodium bicarbonate therapy, a missed dose should be taken as soon as remembered, unless it is close to the time of the next scheduled dose. In that case, skip the missed dose and continue with the regular schedule. Never take a double dose to compensate.
Overdose
Overdose of sodium bicarbonate results in metabolic alkalosis, a condition where the blood becomes excessively alkaline (pH > 7.45). Symptoms of metabolic alkalosis include muscle twitching, tetany (involuntary muscle contractions), cardiac arrhythmias, decreased consciousness, and in severe cases, seizures. Additional complications include hypernatremia (high sodium levels), hypokalemia (low potassium), and hypocalcemia (low ionized calcium).
Treatment of sodium bicarbonate overdose involves immediately stopping the infusion, providing supportive care, and addressing the electrolyte imbalances. In severe cases, acidifying agents such as ammonium chloride or dilute hydrochloric acid may be administered under specialist guidance. Hemodialysis may be required in patients with renal failure who cannot excrete the excess bicarbonate.
| Patient Group | Indication | Typical Dose | Administration |
|---|---|---|---|
| Adults | Cardiac arrest | 1 mEq/kg initial, then 0.5 mEq/kg q10min | IV push or rapid infusion |
| Adults | Metabolic acidosis | Based on base deficit formula | Slow IV infusion with ABG monitoring |
| Children | Cardiac arrest | 1 mEq/kg initial | Slow IV push; use 4.2% in neonates |
| Elderly | Metabolic acidosis | Reduced initial dose; based on renal function | Slow IV infusion with enhanced monitoring |
| Adults (oral) | Chronic acidosis / urinary alkalinization | 1–4 g daily in divided doses | Oral tablets with water |
What Are the Side Effects of Sodium Bicarbonate?
At recommended doses, sodium bicarbonate has no commonly reported side effects. However, excessive or overly rapid administration can cause metabolic alkalosis, hypernatremia, hypokalemia, fluid overload, and paradoxical intracellular acidosis. These complications are prevented through careful dose titration and blood gas monitoring.
One of the notable characteristics of sodium bicarbonate is that, when administered correctly at the appropriate dose and rate, it has an excellent safety profile with no commonly observed adverse effects. The manufacturer's product information specifically states that this medication has no known side effects at recommended dosing. This is because sodium bicarbonate is a naturally occurring substance in the body that participates in the normal physiological bicarbonate buffering system.
However, it is important to distinguish between the absence of side effects at proper doses and the significant risks associated with inappropriate use. The complications listed below are dose-dependent adverse effects that occur primarily with excessive administration, overly rapid infusion, or use in patients with contraindications.
Dose-Dependent Effects (with excessive administration)
Not typical side effects; occur only with overdose or inappropriate use
- Metabolic alkalosis (blood becoming too alkaline, pH > 7.45)
- Hypernatremia (elevated blood sodium levels)
- Hypokalemia (decreased blood potassium levels)
- Hypocalcemia (decreased ionized calcium)
- Fluid overload and peripheral edema
- Paradoxical intracellular acidosis (with poor ventilation)
Local Effects (IV administration)
Uncommon; related to administration technique
- Extravasation injury (tissue damage if solution leaks outside the vein)
- Phlebitis (inflammation of the vein at the injection site)
- Local pain or irritation at the infusion site
Gastrointestinal Effects (oral tablets)
May occur with chronic oral use
- Bloating and flatulence (due to CO₂ generation in the stomach)
- Abdominal discomfort or distension
- Belching
- Nausea (usually mild and transient)
It is essential to emphasize that the dose-dependent complications listed above are largely preventable through proper medical practice. In clinical settings, healthcare professionals monitor arterial blood gases, serum electrolytes (sodium, potassium, calcium), and fluid balance throughout treatment. This careful monitoring allows early detection and correction of any developing imbalances before they become clinically significant.
Reporting Suspected Side Effects
Reporting suspected adverse reactions after a medicine has been authorized is important, as it allows ongoing monitoring of the medication's benefit-risk balance. Healthcare professionals and patients are encouraged to report any suspected side effects to their national pharmacovigilance authority. In the UK, reports can be made to the MHRA via the Yellow Card Scheme. In the EU, reports should be directed to the national competent authority. In the US, the FDA MedWatch program accepts adverse event reports.
How Should Sodium Bicarbonate Be Stored?
Sodium bicarbonate solution should be used immediately after opening. Unopened containers should be stored at room temperature, protected from light, and kept out of the reach of children. Do not use the solution if precipitation has developed during storage.
Proper storage of sodium bicarbonate is essential to maintain its efficacy and safety. The solution should be stored according to the manufacturer's guidelines to prevent degradation and ensure sterility at the time of use.
Storage Conditions
- Temperature: Store at room temperature (15–25°C / 59–77°F). Do not freeze. Do not expose to excessive heat
- Light: Protect from direct light. Keep in the original packaging until ready to use
- After opening: Sodium bicarbonate solution should be used immediately after opening. If not used promptly, the healthcare professional is responsible for proper storage and use in accordance with standard hospital pharmaceutical practices
- Expiry date: Do not use after the expiration date printed on the label. The expiration date refers to the last day of the stated month
- Visual inspection: Do not use the solution if precipitation has formed during storage or if the solution appears cloudy or discolored. The solution should be clear and colorless
- Children: Keep this and all medications out of the sight and reach of children
Once opened, any unused portion of the sodium bicarbonate infusion should be discarded according to local protocols for pharmaceutical waste. The solution does not contain preservatives, so aseptic technique must be maintained during handling. The product is supplied in 100 mL glass bottles sealed with a grey rubber stopper made of ethylene propylene terpolymer.
What Does Natriumbikarbonat Fresenius Kabi Contain?
The active ingredient is sodium bicarbonate (sodium hydrogen carbonate). The only other ingredient is water for injections. The solution is clear, colorless, and supplied in 100 mL glass bottles.
Natriumbikarbonat Fresenius Kabi has a deliberately simple formulation, containing only the active pharmaceutical ingredient and a vehicle (solvent). This minimalistic composition reduces the risk of adverse reactions and incompatibilities.
Active Ingredient
Sodium bicarbonate (sodium hydrogen carbonate, NaHCO₃) is the sole active ingredient. In the infusion solution, it is present at a concentration of 50 mg/mL (5% w/v), which corresponds to approximately 0.6 mEq/mL of both sodium and bicarbonate. The molecular weight is 84.01 g/mol. Sodium bicarbonate is a white, crystalline powder that is freely soluble in water, producing a slightly alkaline solution.
Inactive Ingredients
Water for injections: This is the only excipient (inactive ingredient) in the formulation. Water for injections is produced by distillation and meets strict pharmaceutical purity standards, ensuring it is free from pyrogens, particulate matter, and microbial contamination. It serves as the solvent for dissolving the sodium bicarbonate and provides the necessary volume for intravenous administration.
Product Appearance and Packaging
The infusion solution is a clear, colorless liquid with no visible particles. It is supplied in 100 mL glass bottles, available individually or in packs of 10 (10 × 100 mL). Each bottle is sealed with a grey rubber stopper made of ethylene propylene terpolymer, which is compatible with the alkaline solution and does not leach harmful substances into the product.
The oral tablet formulation contains 1 g of sodium bicarbonate per tablet, with additional pharmaceutical excipients appropriate for solid dosage form manufacture.
Frequently Asked Questions About Sodium Bicarbonate
Sodium bicarbonate is primarily used intravenously in hospitals to treat metabolic acidosis, a condition where the blood becomes dangerously acidic. It is a critical medication in emergency departments and intensive care units, frequently administered during cardiac arrest (as part of ACLS protocols), severe sepsis, diabetic ketoacidosis (DKA), and drug overdoses involving tricyclic antidepressants or salicylates. It works by providing bicarbonate ions that directly neutralize excess hydrogen ions in the blood, thereby restoring normal pH balance. The medication is always administered under careful medical supervision with continuous blood gas monitoring.
There are no known risks associated with sodium bicarbonate use during pregnancy or breastfeeding when administered at recommended doses under medical supervision. Sodium bicarbonate is a naturally occurring substance in the body and is part of the normal bicarbonate buffering system. However, as with all medications during pregnancy, it should only be used when the clinical benefit clearly justifies any theoretical risk, and always under the guidance of a healthcare provider.
At recommended doses, sodium bicarbonate infusion has no commonly reported side effects. The product's safety profile is excellent when used appropriately. However, excessive or overly rapid administration can lead to metabolic alkalosis (blood becoming too alkaline), hypernatremia (high sodium levels), hypokalemia (low potassium), fluid overload, and paradoxical intracellular acidosis. These complications are prevented through careful dose titration guided by arterial blood gas analysis and electrolyte monitoring during treatment.
Yes, sodium bicarbonate is available in oral tablet form (1 g tablets). Oral sodium bicarbonate may be prescribed for chronic metabolic acidosis (such as renal tubular acidosis), urinary alkalinization to enhance elimination of certain drugs, or as an antacid for occasional heartburn relief. However, the Natriumbikarbonat Fresenius Kabi product discussed in this article is primarily the intravenous infusion form (50 mg/mL solution) used in hospital emergency settings. Oral use should always follow your doctor's instructions regarding dose and timing.
The dose of intravenous sodium bicarbonate is individually calculated based on the patient's arterial blood gas (ABG) analysis. The general formula used is: dose (mEq) = base deficit × body weight (kg) × 0.3. Typically, only half the calculated dose is administered initially, followed by a repeat ABG to assess the response before giving additional doses. During cardiac arrest, a standard initial dose of 1 mEq/kg is commonly used according to ACLS guidelines. This individualized approach ensures the acidosis is corrected safely without overcorrecting to alkalosis.
Both Natriumbikarbonat Fresenius Kabi and Natriumbikarbonat Viatris contain the same active ingredient (sodium bicarbonate) at the same concentration and are considered therapeutically equivalent. The differences lie primarily in the manufacturer: Fresenius Kabi AB (based in Uppsala) produces one version, while Viatris (formerly Mylan) manufactures the other. There may be minor differences in available package sizes and excipients, but the clinical efficacy and safety are identical. Your healthcare team will use whichever product is available in their facility.
References and Sources
This article is based on the following international guidelines and peer-reviewed sources. All medical claims reflect current evidence-based practice.
- European Resuscitation Council (ERC). European Resuscitation Council Guidelines 2021: Adult Advanced Life Support. Resuscitation. 2021;161:115-151. doi:10.1016/j.resuscitation.2021.02.010
- American Heart Association (AHA). 2020 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation. 2020;142(16_suppl_2). doi:10.1161/CIR.0000000000000916
- Kraut JA, Madias NE. Treatment of acute metabolic acidosis: a pathophysiologic approach. Nat Rev Nephrol. 2012;8(10):589-601. doi:10.1038/nrneph.2012.186
- Jaber S, Paugam C, Futier E, et al. Sodium bicarbonate therapy for patients with severe metabolic acidaemia in the intensive care unit (BICAR-ICU): a multicentre, open-label, randomised controlled, phase 3 trial. Lancet. 2018;392(10141):31-40. doi:10.1016/S0140-6736(18)31080-8
- World Health Organization (WHO). WHO Model List of Essential Medicines – 23rd list, 2023. Geneva: World Health Organization; 2023.
- British National Formulary (BNF). Sodium bicarbonate. National Institute for Health and Care Excellence (NICE). bnf.nice.org.uk
- European Medicines Agency (EMA). Summary of Product Characteristics: Sodium Bicarbonate. ema.europa.eu
- Velissaris D, Karamouzos V, Ktenopoulos N, et al. The Use of Sodium Bicarbonate in the Treatment of Acidosis in Sepsis: A Literature Update on a Long Term Debate. Crit Care Res Pract. 2015;2015:605830. doi:10.1155/2015/605830
Editorial Team
This article was written and reviewed by the iMedic Medical Editorial Team, consisting of licensed physicians with specialist qualifications in emergency medicine, intensive care, and clinical pharmacology. Our editorial process follows the GRADE evidence framework, and all content is reviewed against current international guidelines from the European Resuscitation Council (ERC), American Heart Association (AHA), WHO, and NICE.
Content developed by specialist physicians with expertise in emergency medicine, critical care pharmacology, and acid-base physiology. All clinical information verified against peer-reviewed literature and current treatment protocols.
Independently reviewed by the iMedic Medical Review Board. Verified for accuracy, completeness, and adherence to GRADE evidence standards. All drug information cross-referenced with BNF, EMA, and FDA databases.
Conflict of Interest: None declared. iMedic receives no funding from pharmaceutical companies. Evidence Level: 1A – Based on systematic reviews, randomized controlled trials, and international treatment guidelines.