Sodium Bicarbonate
Sodium hydrogen carbonate
Also known as: Baking soda · Neut · Zegerid · E500 · monosodium carbonate · natrii bicarbonas · natrii hydrogenocarbonas · sal de vichy · sodium acid carbonate · NaHCO3 · sodium hydrogen carbonate
Reviewed by the VetSheet Veterinary TeamUpdated Apr 5, 2026Evidence-based veterinary reference
Doses are a clinical reference for licensed veterinary professionals. Always confirm against the current label and the individual patient.
Dosing by species
🌎 NA — North America🌍 EU — Europe
Dogs
| Indication | Dose | Route | Frequency | Duration | Region |
|---|---|---|---|---|---|
| Severe metabolic acidosis | mEq of bicarbonate required = 0.5 x body weight in kg x (desired total CO2 mEq/L minus measured total CO2 mEq/L). Give 1/2 of the calculated dose slowly over 3-4 hours IV. | IV | Once | Over 3-4 hours | 🌎 NA |
| Metabolic acidosis secondary to uremia | 0.3 x body weight (kilograms) x the base deficit. Administration of one third of this dose slowly IV and the rest placed in the intravenous fluids. OR 1-2 mEq/kg of bicarbonate can be given as a slow IV bolus if blood gas is not possible. | IV | Once | Over several hours | 🌎 NA |
| Adjunctive therapy of diabetic ketoacidosis | Dose (in mEq) = body weight in kgs. x 0.4 x (12 - patient's bicarbonate) x 0.5. Give above dose over 6 hours in IV fluids. | IV | Once | Over 6 hours | 🌎 NA |
| Adjunctive treatment of hypercalcemic crisis | mEq of bicarbonate required = 0.3 x body weight in kg x (desired plasma bicarbonate mEq/L - measured plasma bicarbonate mEq/L); or 1 mEq/kg IV every 10-15 minutes; maximum total dose: 4 mEq/L | IV | q10-15m | Until effect or max dose | 🌎 NA |
| Adjunctive therapy for hyperkalemic crises | 2-3 mEq/kg IV over 30 minutes (if decreased tissue perfusion/renal failure and no DKA) OR 1-2 mEq/kg IV slowly | IV | Once | Over 30 minutes or slowly | 🌎 NA |
| To alkalinize the urine | 10-90 grains (650 mg-5.85 grams) PO per day | PO | Daily | Ongoing | 🌎 NA |
| Dissolution and/or prevention of urate urolithiasis | 0.5-1 gram (1/8-1/4 tsp.) per 5 kg of body weight three times daily PO | PO | q8h | Ongoing | 🌎 NA |
- Severe metabolic acidosis: Recheck blood gases and assess clinical status. Avoid over-alkalinization.
- Metabolic acidosis secondary to uremia: Avoid rapid IV boluses. Recheck blood gas after 2-4 hours.
- Adjunctive therapy of diabetic ketoacidosis: Only if plasma bicarbonate is <=11 mEq/L. Recheck and repeat if still <=11 mEq/L. Use is controversial.
- Adjunctive therapy for hyperkalemic crises: Must be used judiciously.
- To alkalinize the urine: Goal is urine pH of about 7; avoid pH >7.5.
- Dissolution and/or prevention of urate urolithiasis: Goal is urine pH of 7-7.5.
Cats
| Indication | Dose | Route | Frequency | Duration | Region |
|---|---|---|---|---|---|
| Severe metabolic acidosis | mEq of bicarbonate required = 0.5 x body weight in kg x (desired total CO2 mEq/L minus measured total CO2 mEq/L). Give 1/2 of the calculated dose slowly over 3-4 hours IV. | IV | Once | Over 3-4 hours | 🌎 NA |
| Metabolic acidosis secondary to uremia | 0.3 x body weight (kilograms) x the base deficit. Administration of one third of this dose slowly IV and the rest placed in the intravenous fluids. OR 1-2 mEq/kg of bicarbonate can be given as a slow IV bolus if blood gas is not possible. | IV | Once | Over several hours | 🌎 NA |
| Adjunctive therapy of diabetic ketoacidosis | Dose (in mEq) = body weight in kgs. x 0.4 x (12 - patient's bicarbonate) x 0.5. Give above dose over 6 hours in IV fluids. | IV | Once | Over 6 hours | 🌎 NA |
| Adjunctive treatment of hypercalcemic crisis | mEq of bicarbonate required = 0.3 x body weight in kg x (desired plasma bicarbonate mEq/L - measured plasma bicarbonate mEq/L); or 1 mEq/kg IV every 10-15 minutes; maximum total dose: 4 mEq/L | IV | q10-15m | Until effect or max dose | 🌎 NA |
| Adjunctive therapy for hyperkalemic crises | 2-3 mEq/kg IV over 30 minutes (if decreased tissue perfusion/renal failure and no DKA) OR 1-2 mEq/kg IV slowly | IV | Once | Over 30 minutes or slowly | 🌎 NA |
| To alkalinize the urine | 10-90 grains (650 mg-5.85 grams) PO per day | PO | Daily | Ongoing | 🌎 NA |
- Severe metabolic acidosis: Recheck blood gases and assess clinical status. Avoid over-alkalinization.
- Metabolic acidosis secondary to uremia: Avoid rapid IV boluses. Recheck blood gas after 2-4 hours.
- Adjunctive therapy of diabetic ketoacidosis: Only if plasma bicarbonate is <=11 mEq/L. Recheck and repeat if still <=11 mEq/L. Use is controversial.
- Adjunctive therapy for hyperkalemic crises: Must be used judiciously.
- To alkalinize the urine: Goal is urine pH of about 7; avoid pH >7.5.
Birds
| Indication | Dose | Route | Frequency | Duration | Region |
|---|---|---|---|---|---|
| Metabolic acidosis | 1 mEq/kg initially IV (then SC) for 15-30 minutes to a maximum of 4 mEq/kg | IV/SC | Once | 15-30 minutes | 🌎 NA |
Horses
| Indication | Dose | Route | Frequency | Duration | Region |
|---|---|---|---|---|---|
| Metabolic acidosis (associated with colic) | bicarbonate deficit (HCO3 mEq) = base deficit (mEq/L) x 0.4 x body weight (kg). May administer as a 5% sodium bicarbonate solution. Should not be administered any faster than 1-2 L/hr. | IV | Once | Continuous infusion | 🌎 NA |
- Metabolic acidosis (associated with colic): If pH is <7.3 and base deficit is >10 mEq/L. May be preferable to give as isotonic sodium bicarbonate (150 mEq/L) if dehydrated.
Cattle
| Indication | Dose | Route | Frequency | Duration | Region |
|---|---|---|---|---|---|
| Acidosis | 2-5 mEq/kg IV for a 4-8 hour period | IV | Once | Over 4-8 hours | 🌎 NA |
| Severely dehydrated acidotic calves | Isotonic sodium bicarbonate (156 mEq/L). Most calves require about 2 liters of this solution given over 1-2 hours, then change to isotonic saline and sodium bicarbonate or a balanced electrolyte solution. | IV | Once | Over 1-2 hours | 🌎 NA |
- Severely dehydrated acidotic calves: Isotonic solution: 13 grams of sodium bicarbonate in 1 L of sterile water.
Sheep
| Indication | Dose | Route | Frequency | Duration | Region |
|---|---|---|---|---|---|
| Acidosis (Ruminants) | 2-5 mEq/kg IV for a 4-8 hour period | IV | Once | Over 4-8 hours | 🌎 NA |
Goats
| Indication | Dose | Route | Frequency | Duration | Region |
|---|---|---|---|---|---|
| Acidosis (Ruminants) | 2-5 mEq/kg IV for a 4-8 hour period | IV | Once | Over 4-8 hours | 🌎 NA |
Doses are a clinical reference for licensed veterinary professionals. Always confirm against the current label and the individual patient.
Overview
Sodium bicarbonate is a systemic and urinary alkalinizing agent widely used in veterinary emergency and critical care, as well as for chronic management of specific conditions.
- Emergency Acid-Base Management: Primarily utilized to correct severe metabolic acidosis, particularly when the underlying cause cannot be rapidly reversed and blood pH drops to critically low levels.
- Electrolyte Crises: Serves as an adjunctive treatment for life-threatening hyperkalemia (by driving potassium intracellularly) and hypercalcemia.
- Urinary Alkalinization: Administered orally to manage or prevent specific uroliths (e.g., urate, cystine) by increasing urine pH.
Clinical Pearl: The routine use of sodium bicarbonate in cardiopulmonary resuscitation (CPR) and diabetic ketoacidosis (DKA) has fallen out of favor. In DKA, it can worsen intracellular hypokalemia and cause paradoxical CNS acidosis. In CPR, it can lead to hypercapnia if the patient is not adequately ventilated.
Mechanism of action
Sodium bicarbonate acts as an exogenous source of bicarbonate anion ($HCO_3^-$), which is the primary extracellular buffer in the body.
- Buffering Acidosis: $HCO_3^-$ combines with free hydrogen ions ($H^+$) to form carbonic acid ($H_2CO_3$), which then dissociates into water ($H_2O$) and carbon dioxide ($CO_2$).
- Pathway: $HCO_3^-$ + $H^+$ → $H_2CO_3$ → $H_2O$ + $CO_2$ (The $CO_2$ must be exhaled via the lungs, highlighting the need for adequate ventilation).
- Hyperkalemia Management: By increasing blood pH, it stimulates the $Na^+/H^+$ exchanger and subsequently the $Na^+/K^+$-ATPase pump, driving potassium into cells and rapidly lowering serum potassium levels.
- Urinary Alkalinization: Bicarbonate is excreted in the urine, raising the pH. This increases the solubility of weak acids (like uric acid and cystine) and decreases the solubility of weak bases.
Safety & warnings
Contraindications
- Metabolic or respiratory alkalosis
- Excessive chloride loss secondary to vomiting or GI suction
- Patients at risk for development of diuretic-induced hypochloremic alkalosis
- Hypocalcemia (alkalosis may induce tetany)
- Hypoventilating patients
- Hypercapnoeic patients
- Animals unable to effectively expel carbon dioxide
Adverse effects
- Metabolic alkalosis
- Hypokalemia
- Hypocalcemia
- 'Overshoot' alkalosis
- Hypernatremia
- Volume overload
- Shifts in the oxygen dissociation curve (decreased tissue oxygenation)
- Paradoxical CNS acidosis leading to respiratory arrest
- Hypercapnia (if not well ventilated during CPR)
- Predisposition to ventricular fibrillation
- Hypernatraemia
- Congestive heart failure (due to sodium load)
- Decreased tissue oxygenation (shift in oxygen dissociation curve)
Precautions
Extreme Caution: Use with extreme caution and give very slowly in patients with hypocalcemia to avoid inducing tetany. Caution: Because of the potential sodium load, use with caution in patients with congestive heart failure (CHF), nephrotic syndrome, hypertension, oliguria, acute renal failure, or volume overload. Ventilation: When used during CPR, ensure the patient is well ventilated to prevent hypercapnia and paradoxical CNS acidosis.
Drug interactions
Concomitant oral sodium bicarbonate may reduce absorption; administer separately
Concomitant oral sodium bicarbonate may reduce absorption; administer separately
Solubility is decreased in an alkaline environment; monitor for signs of crystalluria
Patients receiving high dosages of sodium bicarbonate and ACTH or glucocorticoids may develop hypernatremia
Concurrent use in patients receiving potassium-wasting diuretics may cause hypochloremic alkalosis
When urine is alkalinized, excretion may be decreased
Concomitant oral sodium bicarbonate may reduce absorption; administer separately
Concomitant oral sodium bicarbonate may reduce absorption; administer separately
Can increase or reduce absorption rate/extent; avoid giving other drugs within 12 hours of oral sodium bicarbonate
When urine is alkalinized, excretion may be decreased
When urine is alkalinized, excretion of weakly acidic drugs may be increased
Oral sodium bicarbonate may reduce efficacy if administered concurrently
Concomitant oral sodium bicarbonate may reduce absorption; administer separately
Incompatible in solution; do not mix unless checked beforehand (risk of precipitation)
Decreased excretion due to alkalinization of the urine
Increased excretion due to alkalinization of the urine
Increased excretion due to alkalinization of the urine
Increased excretion due to alkalinization of the urine
Monitoring
- Acid/base status (venous or arterial blood gases)
- Serum electrolytes (especially potassium, calcium, and sodium)
- Urine pH (if being used to alkalinize urine)
- Blood gas analysis (pH, pCO2, HCO3-)
- Serum electrolytes (Na+, K+, Ca2+)
- Respiratory rate and effort
- Clinical signs of fluid overload or congestive heart failure
Pharmacokinetics
Absorption
Well absorbed orally.
Distribution
Bicarbonate increases initially in the intravascular space, but is then buffered by intracellular buffers. Diffusion and buffering by intracellular buffers takes approximately 2-4 hours.
Metabolism
Combines with hydrogen ions to form carbonic acid, which dissociates into water and carbon dioxide (exhaled by the lungs).
Elimination
Filtered and reabsorbed by the kidneys; excess is excreted in the urine, resulting in urinary alkalinization.
Overdose
Overdose or overly rapid administration can cause severe alkalosis, leading to irritability, muscle twitching, or tetany (due to a sudden drop in ionized calcium).
- Mild Overdose: May only require discontinuing the bicarbonate therapy or using a rebreathing mask.
- Severe Alkalosis: May require intravenous calcium therapy to treat tetany.
- Electrolyte Correction: Sodium chloride or potassium chloride may be necessary if hypokalemia or hypochloremia is present.
Always thoroughly check dosages and frequently monitor electrolyte and acid/base status during administration.
Available products
Formulations
- Injection: 4%, 4.2%, 5%, 7.5%, 8.4%
- Oral tablets: 325 mg, 650 mg
- Oral powder
- Oral suspension/capsules (combination with omeprazole)
- 1.26% solution for IV infusion
- 4.2% solution for IV infusion
- 8.4% solution for IV infusion (1 mmol/ml)
- 300 mg oral tablet
- 500 mg oral tablet
- 600 mg oral tablet
Veterinary
- Sodium Bicarbonate Injection: 8.4% (1 mEq/mL) in 50 mL, 100 mL, and 500 mL vials
Human-labeled
- Sodium Bicarbonate Neutralizing Additive Solution: 4% (0.48 mEq/mL), 4.2% (0.5 mEq/mL)
- Sodium Bicarbonate Injection: 4.2%, 5%, 7.5%, 8.4%
- Sodium Bicarbonate Tablets: 325 mg & 650 mg (OTC)
- Sodium Bicarbonate Powder: 120 grams, 300 grams & 1 lb (OTC)
- Omeprazole/Sodium Bicarbonate Capsules (Zegerid): 20 mg/1,100 mg & 40 mg/1,100 mg
- Omeprazole/Sodium Bicarbonate Powder for Oral Suspension (Zegerid): 20 mg/1,680 mg & 40 mg/1,680 mg
- 1.26% IV infusion
- 4.2% IV infusion
- 8.4% IV infusion
- 300 mg tablets
- 500 mg tablets
- 600 mg tablets
Regulatory status
POM (Prescription Only Medicine)
POM-V
No regulatory data for: 🇺🇸 US · 🇭🇰 HK · 🇹🇼 TW · 🇯🇵 JP · 🇰🇷 KR · 🇦🇺 AU
Storage & stability
Tablets should be stored in tight containers at room temperature (15-30°C). Injection should be stored at temperatures less than 40°C (preferably room temperature); avoid freezing. Powder is stable in dry air but will slowly decompose upon exposure to moist air.
Client information
Sodium Bicarbonate (commonly known as baking soda) is used medically to make your pet's blood or urine less acidic.
- Administration: If giving oral tablets or powder, follow your veterinarian's exact dosing. Do not substitute household baking soda unless specifically instructed by your vet, as dosing can be imprecise and potentially dangerous.
- Timing with Other Meds: Give this medication at least 12 hours apart from other oral medications if possible, as it changes stomach acid levels and can severely affect how other drugs are absorbed.
- Monitoring: Your vet will likely need to check your pet's blood work or urine pH regularly to ensure the dose is correct and safe.
- Side Effects to Watch For: Watch for signs of fluid retention (like rapid breathing, coughing, or swelling), muscle twitching, or weakness. Contact your vet immediately if you notice any unusual behavior or symptoms.
VetSheet drug reference is intended for licensed veterinary professionals as a clinical decision-support aid, not a substitute for professional judgement or the manufacturer’s current label.