sodium bicarbonate

Sodium bicarbonate is a chemical compound made of sodium and bicarbonate used to increase the alkalinity of the body. Sodium bicarbonate raises the pH levels in the body and reduces the acidity of body fluids and tissues. Intravenous sodium bicarbonate is used to treat metabolic acidosis caused by many conditions, and high potassium levels (hyperkalemia) that can result in cardiac arrest.

Intravenous sodium bicarbonate is also used as an antidote for metabolic acidosis due to toxicity from many drugs including barbiturates, salicylates, tetracyclic antidepressants, cyanide, and cocaine. Oral sodium bicarbonate is an antacid that reduces stomach acidity and is used to temporarily relieve symptoms of acid indigestion, heartburn, and upset stomach. Treatment of the primary cause of metabolic acidosis should be instituted in addition to sodium bicarbonate therapy.

After administration, sodium and bicarbonate separate in the blood. Bicarbonate reacts with hydrogen ions to form water and carbon dioxide which is eliminated from the lungs. By absorbing the excess hydrogen ions and increasing the water content in the blood and other body fluids, bicarbonate raises the pH level and restores acid/base balance in the body.

Intravenous sodium bicarbonate injection/infusion is used in the treatment of following conditions:

• Metabolic acidosis that may occur from:
• Severe renal disease
  • Uncontrolled diabetes
  • Circulatory insufficiency due to shock
  • Severe dehydration
  • Extracorporeal circulation of blood
  • Cardiac arrest
  • Severe primary lactic acidosis
  • Drug toxicities
  • Severe diarrhea with bicarbonate loss
• Cardiac arrest due to:
  • High potassium levels (hyperkalemia)
  • Metabolic acidosis
  • Tricyclic antidepressant overdose

• Do not administer to patients with hypersensitivity to sodium bicarbonate or any of its components
• Do not administer sodium bicarbonate injection to patients who:
  • Have chloride loss due to vomiting or from continuous gastrointestinal suction
  • Are being treated with diuretics that are known to cause chloride loss (hyperchloremic alkalosis)
• Do not use sodium carbonate as a first-line for resuscitation; should ideally be given after adequate ventilation and the initiation of cardiac compressions
• Use with caution in patients with severe renal insufficiency, hypertension, congestive heart failure, fluid/sodium retention, concurrent corticosteroid use, and children with diabetic ketoacidosis
• Administer carefully to avoid leakage from the vein (extravasation); may cause chemical cellulitis, tissue death (necrosis), ulceration and sloughing of skin due to alkalinity
• Intravenous administration can cause fluid and/or solute overloading resulting in dilution of electrolyte concentrations in the blood, overhydration, congested states or fluid in the lungs (pulmonary edema)
• Can cause loss of potassium and calcium leading to excessive alkalinity (metabolic alkalosis); treat appropriately before or during the infusion to minimize the risk of such electrolyte imbalance

Common side effects of sodium bicarbonate include:

• Excessive alkalinity (metabolic alkalosis) with symptoms including:
  • Muscle pain and twitching
  • Irritability
  • Involuntary muscle contractions and spasms (tetany)
• High sodium levels in blood (hyponatremia)
• Low potassium levels (hypokalemia)
• Low calcium levels (hypocalcemia)
• Cerebral hemorrhage
• Increased acid level in the brain tissue (intracranial acidosis)
• Exacerbation of congestive heart failure (CHF)
• Swelling (edema)
• Fluid in the lungs (pulmonary edema)
• Increased urinary frequency
• Abdominal distension
• Belching
• Nausea or vomiting
• Unpleasant taste
• Headache
• Nervousness or restlessness
• Slow respiratory rate (bradypnea)
• High concentration of chemicals and electrolytes in blood (hyperosmolality)
• Secondary to drug leakage from the vein (extravasation)
  • Tissue damage and death (necrosis) at injection site
  • Chemical cellulitis
• Milk-alkali syndrome, a condition characterized by a triad of elevated levels of calcium (hypercalcemia), metabolic alkalosis, and acute kidney injury

This is not a complete list of all side effects or adverse reactions that may occur from the use of this drug.

Call your doctor for medical advice about serious side effects or adverse reactions. You may also report side effects or health problems to the FDA at 1-800-FDA-1088.

Injectable Solution

• 4%
• 4.2%
• 7.5%
• 8.4%

Tablet

• 325mg
• 650mg

Adult:

Antacid

• Oral: 325 mg to 2 g 1 to 4 times/day.

Cardiac Arrest

• Initial: 1 mEq/kg/dose IV x1; base subsequent doses on results of arterial blood pH and PaCO2 as well as calculation of base deficit
• Repeat doses may be considered in the setting of prolonged cardiac arrest only after adequate alveolar ventilation has been established

Hyperkalemia

• 50 mEq intravenous (IV) over 5 minutes

Metabolic Acidosis

• Non-life-threatening: 2-5 mEq/kg IV infusion over 4-8 hr depending on the severity of acidosis as judged by the lowering of total CO2 content, clinical condition and pH
• Severe (except hypercarbic acidosis): 90-180 mEq/L (~7.5-15 g) at a rate of 1-1.5 L (first hour); adjust for further management as needed

Dosing Considerations

• Monitor pH, serum potassium, and CO2

Pediatric:

Cardiac Arrest

Infants younger than 2 years (use 4.2% solution)

• Initial: 1 mEq/kg/min given over 1-2 minutes IV/IO, THEN
• 1 mEq/kg IV q10min of arrest
• Not to exceed 8 mEq/kg/day

Children 2 years and older

• Initial: 1 mEq/kg/dose IV x1; base subsequent doses on results of arterial blood pH and PaCO2 as well as calculation of base deficit
• Repeat doses may be considered in the setting of prolonged cardiac arrest only after adequate alveolar ventilation has been established

Metabolic Acidosis (Non-Life-Threatening)

• Older children: 2-5 mEq/kg IV infusion over 4-8 hr depending on the severity of acidosis as judged by the lowering of total CO2 content, clinical condition and pH
• 0.25-2mEq/kg IV infusion can be considered for acidosis with a pH <7.0-7.2

Dosing Considerations

Monitor serum potassium

• Overdosage of sodium bicarbonate increases the alkalinity of body fluids which results in alkalosis.
• In case of overdose, sodium bicarbonate administration must be immediately discontinued and treatment should be instituted depending on the degree of alkalosis.
• Alkalosis may be treated with sodium chloride injection and potassium chloride, if potassium levels are low (hypokalemia).
• Symptoms of severe alkalosis may be managed with calcium gluconate, in addition to treating with an acidifying agent such as ammonium chloride.

Inform your doctor of all medications you are currently taking, who can advise you on any possible drug interactions. Never begin taking, suddenly discontinue, or change the dosage of any medication without your doctor’s recommendation.

• Sodium bicarbonate has no severe interactions
• Sodium bicarbonate has serious interactions with at least 22 different drugs.
• Sodium bicarbonate has moderate interactions with at least 94 different drugs.
• Mild interactions of sodium bicarbonate include:
  • aspirin
  • aspirin rectal
  • aspirin/citric acid/sodium bicarbonate
  • balsalazide
  • choline magnesium trisalicylate
  • chromium
  • diflunisal
  • mesalamine
  • salicylates (non-ASA)
  • sulfasalazine

The drug interactions listed above are not all of the possible interactions or adverse effects. For more information on drug interactions, visit the RxList Drug Interaction Checker.

It is important to always tell your doctor, pharmacist, or health care provider of all prescription and over-the-counter medications you use, as well as the dosage for each, and keep a list of the information. Check with your doctor or health care provider if you have any questions about the medication.

• It is not known if sodium bicarbonate can cause fetal harm when administered during pregnancy, or if it can affect reproduction capacity; use if clearly needed
• It is not known if sodium bicarbonate is excreted in breast milk

• Take oral sodium bicarbonate exactly as directed.
• Avoid sodium bicarbonate if you are on a salt-restricted diet.