# Sodium bicarbonate

Indication-specific adult treatment and pediatric source-chart guidance.

Population: Adult & pediatric guidance. Scope: ALS.
Status: published. Source-linked OCEMS summary.
Summary updated: 2026-09-16.
Source checked: 2026-09-16.
Source version: I-15 revised March 31, 2026; I-20 revised March 26, 2026. Both implemented April 1, 2026. See linked condition-specific sources..
Canonical page: https://www.ocmedic.com/guides/sodium-bicarbonate/
Official source: [I-15 — Adult / Adolescent Standing Order Drug Guide](https://www.ochealthinfo.com/sites/healthcare/files/2026-04/I-15%20Adult%20SO%20Drug%20Guide%2004-2026.pdf)

Independent OC Medic summary. Does not replace the complete policy, current system notices, or clinical judgment.

## Check before giving

- Confirm whether the preparation is 7.5% or 8.4%, and distinguish milliliters from mEq.
- I-15 specifies IO use when the patient is unconscious and IV access cannot be established.

## Source documents

- [I-15 — Adult / Adolescent Standing Order Drug Guide](https://www.ochealthinfo.com/sites/healthcare/files/2026-04/I-15%20Adult%20SO%20Drug%20Guide%2004-2026.pdf#page=5)
- [I-20 — Pediatric Medication Volume Dose by Weight](https://www.ochealthinfo.com/sites/healthcare/files/2026-04/I-20%20Peds%20Drug%20Guide%2004-2026.pdf)
- [SO-C-010 — Cardiopulmonary Arrest - Adult / Adolescent Non-Traumatic](https://www.ochealthinfo.com/sites/hca/files/2021-06/SO-C-10%20Cardopulmonary%20Arrest%20-%20AdultAdolescent%20Non-Traumatic%20%2810-1-2021%29%20-%20Revised.pdf)
- [SO-P-040 — Cardiopulmonary Arrest - Pediatric](https://www.ochealthinfo.com/sites/healthcare/files/2025-11/SO-P-40%20Cardiac%20Arrest%2011-25.pdf)
- [SO-T-020 — Crush Injury - Adult / Adolescent](https://www.ochealthinfo.com/sites/healthcare/files/2024-07/SO-T-20%20Crush%20injury%20adult.pdf)

## Use in OCEMS

- I-15 lists major-muscle crush injury lasting more than 1 hour and cardiac arrest after 10 minutes of arrest management.
- Use the applicable resuscitation/crush order; this is not a routine medication for every arrest or every acidosis.

## Adult / adolescent

| Indication / route | Dose & limits |
| --- | --- |
| I-15 listed indications | One 50 mL prefilled syringe IV or IO. Inventory includes 8.4% (1 mEq/mL) and 7.5% (44.6 mEq/50 mL) preparations, which do not contain identical mEq totals. |

## Pediatric

- I-20 contains a sodium-bicarbonate row with IV/IO dose and volume by weight band; the smallest-weight entries include a 1:1 saline dilution note.
- The current SO-P-040 arrest pathway does not list routine bicarbonate. A chart entry alone does not establish an indication or authority: confirm the relevant pediatric order/base direction and exact concentration before use.

## Pediatric dosing availability

- I-20 has preparation rows, but SO-P-040 does not authorize routine pediatric arrest bicarbonate. A separate applicable indication/order is needed; no routine pediatric dose is recommended here.
| Weight | OCEMS pediatric dose |
| --- | --- |
| Any weight | No general pediatric dose under the cited source; follow the applicable order / medical direction. |

## Preparation & reassessment

- Reconcile the requested dose with the actual concentration and any dilution instruction.
- Document indication, formulation, dose/volume, route, and response. Continue the underlying resuscitation or crush-injury pathway.