碳酸氫鈉
Sodium Bicarbonate
Sodium hydrogen carbonate
別名: Baking soda · Neut · Zegerid · E500 · monosodium carbonate · natrii bicarbonas · natrii hydrogenocarbonas · sal de vichy · sodium acid carbonate · NaHCO3 · sodium hydrogen carbonate
由 VetSheet 獸醫團隊審訂更新於 2026年4月5日本內容以實證獸醫文獻為本
劑量為持牌獸醫專業人員的臨床參考。請務必對照最新藥品說明書及個別病患確認。
各物種劑量
🌎 NA — North America🌍 EU — Europe
狗
| 適應症 | 劑量 | 途徑 | 頻次 | 療程 | 地區 |
|---|---|---|---|---|---|
| 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.
貓
| 適應症 | 劑量 | 途徑 | 頻次 | 療程 | 地區 |
|---|---|---|---|---|---|
| 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.
鳥
| 適應症 | 劑量 | 途徑 | 頻次 | 療程 | 地區 |
|---|---|---|---|---|---|
| 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 |
馬
| 適應症 | 劑量 | 途徑 | 頻次 | 療程 | 地區 |
|---|---|---|---|---|---|
| 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.
牛
| 適應症 | 劑量 | 途徑 | 頻次 | 療程 | 地區 |
|---|---|---|---|---|---|
| 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.
羊
| 適應症 | 劑量 | 途徑 | 頻次 | 療程 | 地區 |
|---|---|---|---|---|---|
| Acidosis (Ruminants) | 2-5 mEq/kg IV for a 4-8 hour period | IV | Once | Over 4-8 hours | 🌎 NA |
山羊
| 適應症 | 劑量 | 途徑 | 頻次 | 療程 | 地區 |
|---|---|---|---|---|---|
| Acidosis (Ruminants) | 2-5 mEq/kg IV for a 4-8 hour period | IV | Once | Over 4-8 hours | 🌎 NA |
劑量為持牌獸醫專業人員的臨床參考。請務必對照最新藥品說明書及個別病患確認。
概覽
碳酸氫鈉是一種全身性及尿液鹼化劑，廣泛應用於獸醫急診與重症監護，以及特定疾病的慢性管理。
- 急診酸鹼管理：主要用於校正嚴重的代謝性酸中毒，特別是當潛在原因無法迅速逆轉且血液 pH 值降至危險水平時。
- 電解質危機：作為危及生命的高血鉀症（促使鉀離子進入細胞內）及高血鈣症的輔助治療。
- 尿液鹼化：口服給藥以提高尿液 pH 值，用於管理或預防特定尿結石（如尿酸鹽、胱氨酸結石）。
臨床要點：在心肺復甦（CPR）和糖尿病酮酸血症（DKA）中常規使用碳酸氫鈉的做法已不被推薦。在 DKA 中，它可能惡化細胞內低血鉀並引起矛盾性中樞神經系統酸中毒；在 CPR 中，若病患未獲得充分通氣，可能導致高碳酸血症。
作用機制
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.
安全性與警告
禁忌症
- 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
不良反應
- 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)
注意事項
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.
藥物相互作用
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
監測
- 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
藥物動力學
吸收
Well absorbed orally.
分佈
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.
代謝
Combines with hydrogen ions to form carbonic acid, which dissociates into water and carbon dioxide (exhaled by the lungs).
排除
Filtered and reabsorbed by the kidneys; excess is excreted in the urine, resulting in urinary alkalinization.
過量
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.
可用產品
劑型
- 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
獸醫用
- Sodium Bicarbonate Injection: 8.4% (1 mEq/mL) in 50 mL, 100 mL, and 500 mL vials
人用標示
- 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
各地核准狀態
POM (Prescription Only Medicine)
POM-V
暫無法規資料: 🇺🇸 US · 🇭🇰 HK · 🇹🇼 TW · 🇯🇵 JP · 🇰🇷 KR · 🇦🇺 AU
儲存與穩定性
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.
飼主須知
碳酸氫鈉（俗稱小蘇打）在醫學上用於降低寵物血液或尿液的酸度。
- 給藥方式：如果給予口服錠劑或粉末，請嚴格遵循獸醫師的劑量指示。請勿使用家用小蘇打粉替代，除非獸醫師特別指示，因為劑量可能不精確且具潛在危險。
- 與其他藥物的間隔：請盡可能與其他口服藥物間隔 12 小時給予，因為它會改變胃酸濃度，嚴重影響其他藥物的吸收。
- 監測：您的獸醫師可能需要定期檢查寵物的血液或尿液 pH 值，以確保劑量正確且安全。
- 需注意的副作用：觀察是否有體液滯留的跡象（如呼吸急促、咳嗽或水腫）、肌肉抽搐或虛弱。如果您發現任何異常行為或症狀，請立即聯繫您的獸醫師。
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