ce an appreciable time interval may elapse before all of the ancillary effects are brought about, bicarbonate therapy is indicated to minimize risks inherent to the acidosis itself. vigorous bicarbonate therapy is required in any form of metabolic acidosis where a rapid increase in plasma total co2 content is crucial ― e.g., cardiac arrest, circulatory insufficiency due to shock or severe dehydration, and in severe primary lactic acidosis or severe diabetic acidosis.

ernatremia, decreasing cerebrospinal fluid pressure and inducing intracranial hemorrhage. in less urgent forms of metabolic acidosis, sodium bicarbonate injection, usp may be added to other intravenous fluids. the amount of bicarbonate to be given to older children and adults over a four-to-eight-hour period is approximately 2 to 5 meq/kg of body weight — depending upon the severity of the acidosis as judged by the lowering of total co2 content, blood ph and clinical condition of the patient. in metabolic acidosis associated with shock, therapy should be monitored by measuring blood gases, plasma osmolarity, arterial blood lactate, hemodynamics and cardiac rhythm. bicarbonate therapy should always be planned in a stepwise fashion since the degree of response from a given dose is not precisely predictable. initially an infusion of 2 to 5 meq/kg body weight over a period of 4 to 8 hours will produce a measurable improvement in the abnormal acid-base status of the blood. the next step of therapy is dependent upon the clinical response of the patient. if severe symptoms have abated, then the frequency of administration and the size of the dose may be reduced. in general, it is unwise to attempt full correction of a low total co2 content during the first 24 hours of therapy, since this may be accompanied by an unrecognized alkalosis because of a delay in the readjustment of ventilation to normal. owing to this lag, the achievement of total co2 content of about 20 meq/liter at the end of the first day of therapy will usually be associated with a normal blood ph. further modification of the acidosis to completely normal values usually occurs in the presence of normal kidney function when and if the cause of the acidosis can be controlled. values for total co2 which are brought to normal or above normal within the first day of therapy are very likely to be associated with grossly alkaline values for blood ph, with ensuing undesired side effects. parenteral drug products should be inspected visually for particulate matter and discoloration prior to administration, whenever solution and container permit. see precautions. do not use unless solution is clear and the container or seal is intact. discard unused portion.

rbonate) is present in the extracellular fluid. in a healthy adult with normal kidney function, practically all the glomerular filtered bicarbonate ion is reabsorbed; less than 1% is excreted in the urine.