Here are the answers to your Questions comrade 💊💉
1. Why is 1 ml of 5% Sodium bicarbonate added first to artesunate preparation? The answer is Artesunate injection is manufactured in artesunic acid. In artesunic acid form, it is inactive so to activate it 1ml of 5% Sodium Bicarbonate has to added in to the apoule to convert it to Hemmisuccinate ester which is the therapeutically active form . Additions of 0.9 % Nacl is to make the preparation ready/suitable to be injected either via i.m/i.v.
So If you begin with 0.9% Nacl in reconstituting this preparation you more likely to produce Sodium Artesunate ester which is therapeutically inactive.
Hope this Answer clears your curiosity.