Doses - SODIUM BICARBONATE

Dogs & Cats:

For severe metabolic acidosis:
a) Main therapeutic goal should be to eliminate the underlying cause of acidosis. If causesare not readily reversible, if arterial pH is <7.2 (7.1 if diabetic ketoacidosis), andventilatory procedures have not reduced acidemia, bicarbonate therapy should beconsidered. mEq of bicarbonate required = 0.5 x body weight in kgs. x (desired total
CO2 mEq/L - measured total CO2 mEq/L). Give 1/2 of the calculated dose slowly over3-4 hours IV. Recheck blood gases and assess the clinical status of the patient. Avoidover-alkalinization. (Schaer 1986)
For adjunctive therapy of diabetic ketoacidosis:
a) If plasma bicarbonate is ?11 mEq/L give bicarbonate therapy. Dose (in mEq) = bodyweight in kgs. x 0.4 x (12 - patient's bicarbonate) x 0.5. Give above dose over 6 hoursin IV fluids and then recheck plasma bicarbonate or total venous CO2. If still ?11mEq/L, recalculate dose and repeat therapy. (Nelson and Feldman 1988)
For metabolic acidosis in acutely critical situations (cardiac arrest):
a) 1 mEq/kg IV initially, followed by 0.5 mEq/kg at 10-15 minute intervals during CPR.(Moses 1988)
b) Give none during the first 5-10 minutes of arrest, then 0.5 mEq/kg every 5 minutes ofcardiac arrest thereafter. (Haskins 1989)
For adjunctive treatment of hypercalcemic crisis:
a) mEq of bicarbonate required = 0.3 x body weight in kgs. x (desired plasma bicarbonatemEq/L - measured plasma bicarbonate mEq/L); or 1.0 mEq/kg IV every 10-15 minutes;maximum total dose: 4 mEq/L. (Kruger, Osborne, and Polzin 1986)
For adjunctive therapy for hyperkalemic crises:
a) If serum bicarbonate or total CO2 is unavailable: 2 - 3 mEq/kg IV over 30 minutes if patient has decreased tissue perfusion or renal failure and does not have diabetic ketoacidosis. Must be used judiciously. (Willard 1986)
Metabolic acidosis secondary to renal failure:
a)

Dogs:

Initial dose: 8-12 mg/kg PO q8h; adjust dosage to attain blood total CO2 concentrations to 18-24 mEq/L for renal failure. Although, inferior to monitoring total CO2, urine pH may be used as a guideline for adjusting dosage. Urine pH should be between6.5 and 7.0. (Polzin and Osborne 1985)
b) Initial dose: 8-12 mg/kg q8h; adjust dosage to attain blood total CO2 concentrations to18-24 mEq/L. (Allen 1989)
To alkalinize the urine:
a) Dosage must be individualized to the patient. Initially give 10 - 90 grains (650 mg - 5.85grams) PO per day, depending on the size of the patient and the pretreatment urine pHvalue. Goal of therapy is to maintain a urine pH of about 7; avoid pH > than 7.5.(Osborne et al. 1989)
b) For adjunctive therapy in dissolution and/or prevention of urate urolithiasis in dogs: 0.5- 1 gram (1/8 - 1/4 tsp) per 5 kg of body weight tid PO. Goal of therapy is to attain aurine pH of from 7 - 7.5. (Senior 1989)

Horses:

For metabolic acidosis:
a) Associated with colic; if pH is <7.3 and base deficit is >10 mEq/L estimate bicarbonaterequirement using the formula: bicarbonate deficit (HCO-3 mEq) = base deficit(mEq/L) x 0.4 x body weight (kg). May administer as a 5% sodium bicarbonate solution. Each L of solution contains 600 mEq of bicarbonate (hypertonic) and should notbe administered any faster than 1 - 2 L/hr. Because acidotic horses with colic tend alsoto be dehydrated, may be preferable to give as isotonic sodium bicarbonate (150mEq/L). (Stover 1987)

Ruminants:

For acidosis:
a) 2 - 5 mEq/kg IV for a 4-8 hour period. (Howard 1986)
b) For severely dehydrated (10-16 % dehydrated) acidotic calves (usually comatose): Useisotonic sodium bicarbonate (156 mEq/L). Most calves require about 2 liters of thissolution given over 1-2 hours, then change to isotonic saline and sodium bicarbonate ora balanced electrolyte solution. Isotonic sodium bicarbonate may be made by dissolving13 grams of sodium bicarbonate in 1 L of sterile water. Isotonic saline and sodiumbicarbonate may be made by mixing 1 L of isotonic saline with 1 L of isotonic sodiumbicarbonate. (Radostits 1986)

Birds:

For metabolic acidosis:
a) 1 mEq/kg initially IV (then SQ) for 15-30 minutes to a maximum of 4 mEq/kg. (Clubb1986)
Monitoring Parameters -

1) Acid/base status

2) Serum electrolytes

3) Urine pH (if being used to alkalinize urine)
Dosage Forms/Preparations/FDA Approval Status/Withholding Times - Veterinary-Approved Products:
Sodium bicarbonate 5% (0.6 mEq/ml) in 500 ml vials (297.5 mEq/500 ml)
Sodium bicarbonate 8.4% (1 mEq/ml) in 50 ml (50 mEq/vial), 100 ml (100 mEq/vial) and 500ml (500 mEq/vial) vials
Available generically labeled; (Rx). Approval status unknown.

Human-Approved Products:

Injectable Products:
Sodium bicarbonate 4% (0.48 mEq/ml) in 5 & 10 ml vials
Sodium bicarbonate 4.2% (0.5 mEq/ml) in 5 & 10 ml syringes
Sodium bicarbonate 5% (0.6 mEq/ml) in 500 ml vials (297.5 mEq/500 ml)
Sodium bicarbonate 7.5% (0.9 mEq/ml) in 50 ml amps, syringes and vials (44.6 mEq/50 ml)
Sodium bicarbonate 8.4% (1 mEq/ml) in 10 ml syringes (10 mEq) & 50 ml vials (50mEq/vial)
Available generically labeled; (Rx).
Oral Products:
Oral Tablets 325 mg (5 grain), 650 mg (10 grain)
May be labeled generically or as Soda Mint; (OTC)
Sodium Bromide - see Bromide Salts
Sodium Chloride Injections - see the Intravenous Fluids section in the appendix
Sodium Citrate - see Citrate Salts
Sodium Hyaluronate - see Hyaluronate Sodium