In diarrhea, sodium bicarbonate can be infused as an isotonic 1.3% bicarbonate drip (made by adding 150 mEq NaHCO3 in 1000ml 5% Dextrose) at a rate of 250ml/hr. 20 - 40 mEq of potassium should be added to this drip if hypokalemia is a concern.

HYPERKALEMIA

Intravenous bicarbonate has no role in the acute treatment of hyperkalemia, but may slowly attenuate hyperkalemia with sustained administration over several hours. Hypertonic intravenous bolus of undiluted ampules of NaHCO3 has little effect on potassium levels.

Toxicity associated with ingestion of methanol, ethylene glycol, diethylene glycol, phenol and formic acid should be treated with specific therapeutic measures as indicated. NaHCO3 should be given if pH falls below 7.3 and correction should be done till pH normalises (7.35-7.45)

SALICYLATE TOXICITY: Urine alkalinization is advisable in patients with salicylate levels greater than 30 mg/dL, significant acid-base disturbance, or increasing salicylate levels. This is most often achieved via administration of a isotonic bicarbonate drip.

Management of Intraventricular conduction defects manifesting as widened QRS complex in ECG in cases of sodium channel blocker toxicity (TCA, SNRI, Class 1 antiarryhthmics, antihistaminics), cocaine toxicity and propranolol toxicity

Nebulisation of NaHCO3 can be used in patients exposed to chlorine, chloramine or hydrogen chloride gas.

Forced Alkaline Diuresis (FAD) is mentioned in standard treatment guidelines on management of snake bite by ministry of health & family welfare, Government of India and can help in prevention of ATN/AKI in vasculotoxic snake bite.

URANIUM ISOTOPE INHALATION/

INGESTION

Isotonic 1.3% bicarbonate infusion to maintain a urinary pH of 8-9 is given which will prevent nephrotoxic effects of uranium. Treatment is given for 3 days.

Bicarbonate therapy is of questionable value in the following
💥Tumour Lysis Syndrome
💥Rhabdomyolysis
💥Prevention of contrast induced nephropathy
💥Lithium overdose
💥Barbiturate poisoning
💥Cardiac arrest (except if caused by Na channel blocker overdose where it has a role.)

References

I couldn’t get a standard textbook reference regarding the maximum rate of infusion of NaHCO3. It is mentioned to be not more than 1.5mEq/kg/hr in the following.
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