Compatibility of Sodium Bicarbonate with D5W in IV Fluids

Clinical Applications

The American Academy of Pediatrics recommends using only 0.5 mEq/mL concentration for newborn infants, with dilution of available stock solutions as necessary 1
Sodium bicarbonate in D5W is commonly used for treatment of metabolic acidosis after effective ventilation has been established, management of hyperkalemia, and treatment of sodium channel blocker toxicity, particularly tricyclic antidepressant overdose 1
Sodium bicarbonate infusion can cause extracellular alkalosis, hypernatremia, hyperosmolarity, and excess CO2 production 1

Adrenergic drugs (catecholamines) should not be mixed with sodium bicarbonate or other alkaline solutions in the same IV line, as adrenergic agents are inactivated in alkaline solutions 3
Treatment of sodium channel blocker toxicity, particularly tricyclic antidepressant overdose, can be done using sodium bicarbonate in D5W 2