Sodium Bicarbonate

Sodium bicarbonate is indicated in the treatment of metabolic acidosis which may occur in severe renal disease, uncontrolled diabetes, circulatory insufficiency due to shock or severe dehydration, extracorporeal circulation of blood, cardiac arrest and severe primary lactic acidosis. Sodium bicarbonate is further indicated in the treatment of certain drug intoxications, including barbiturates (where dissociation of the barbiturate-protein complex is desired), in poisoning by salicylates or methyl alcohol and in hemolytic reactions requiring alkalinization of the urine to diminish nephrotoxicity of hemoglobin and its breakdown products. Sodium bicarbonate also is indicated in severe diarrhea, which is often accompanied by a significant loss of bicarbonate.

• Treatment of metabolic acidosis should, if possible, be superimposed on measures designed to control the basic cause of the acidosis – e.g., insulin in uncomplicated diabetes, blood volume restoration in shock. But since an appreciable time interval may elapse before all of the ancillary effects are brought about, bicarbonate therapy is indicated to minimize risks inherent to the acidosis itself.
• Vigorous bicarbonate therapy is required in any form of metabolic acidosis where a rapid increase in plasma total CO2 content is crucial – e.g., cardiac arrest, circulatory insufficiency due to shock or severe dehydration, and in severe primary lactic acidosis or severe diabetic acidosis.

Adult and Pediatric Dosage Forms and Strengths

Injectable solution

• 4%
• 4.2%
• 7.5%
• 8.4%

Tablet

• 325 mg
• 650 mg

Cardiac Arrest

• Adult, Initial: 1 mEq/kg/dose intravenous (IV) x1; base subsequent doses on results of arterial blood pH and PaCO2 as well as calculation of the base deficit
  • Repeat doses may be considered in the setting of prolonged cardiac arrest only after adequate alveolar ventilation has been established
• Infants, under 2 years (use 4.2% solution)
• Initial: 1 mEq/kg/min given over 1-2 minutes intravenous/intraosseous (IV/IO), THEN
  • 1 mEq/kg IV q10min of arrest
  • Not to exceed 8 mEq/kg/day
• Children over 2 years
  • Initial: 1 mEq/kg/dose intravenous (IV) x1; base subsequent doses on results of arterial blood pH and PaCO2 as well as calculation of the 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)

• Adult: 2-5 mEq/kg intravenous (IV) infusion over 4-8 hours depending on the severity of acidosis as judged by the lowering of total CO2 content, clinical condition, and pH
• Older children: 2-5 mEq/kg IV infusion over 4-8 hours depending on the severity of acidosis as judged by the lowering of total CO2 content, clinical condition, and pH

Severe Metabolic Acidosis (Except Hypercarbic Acidosis)

• 90 to 180 mEq/L (~ 7.5-15 g) at a rate of 1-1.5 L (first hour); adjust for further management as needed

Administration

• Monitor: serum potassium

Common side effects of sodium_bicarbonate include:

• Aggravated congestive heart failure (CHF)
• Cerebral hemorrhage
• Swelling (edema)
• High blood sodium levels
• Low blood calcium levels
• Low blood potassium levels
• Muscle spasms (associated with low calcium levels)
• Metabolic alkalosis
• Belching
• Bloating
• Excess fluid in the lungs (pulmonary edema)
• Hyperosmolality
• Intracranial acidosis
• Milk-alkali syndrome

This is not a complete list of side effects and other serious side effects may occur. Call your doctor for information and medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

If your doctor has directed you to use this medication for your condition, your doctor or pharmacist may already be aware of any possible drug interactions or side effects and may be monitoring you for them. Do not start, stop, or change the dosage of this medicine or any medicine before getting further information from your doctor, healthcare provider, or pharmacist first.

Severe interactions of sodium_bicarbonate include:

• None

Sodium bicarbonate has serious interactions with at least 24 different drugs.

Sodium bicarbonate has moderate interactions with at least 93 different drugs.

Mild interactions of sodium bicarbonate include:

• aspirin
• aspirin rectal
• aspirin/citric acid/sodium bicarbonate
• balsalazide
• blessed thistle
• choline magnesium trisalicylate
• chromium
• devil's claw
• diflunisal
• mesalamine
• salicylates (non-ASA)
• salsalate
• strontium ranelate
• sulfasalazine
• willow bark

This document does not contain all possible interactions. Therefore, before using this product, tell your doctor or pharmacist of all the products you use. Keep a list of all your medications with you, and share the list with your doctor and pharmacist. Check with your physician if you have health questions or concerns.

Warnings

This medication contains sodium bicarbonate. Do not take sodium bicarbonate if you are allergic to sodium bicarbonate or any ingredients contained in this drug.

Keep out of reach of children. In case of overdose, get medical help or contact a Poison Control Center immediately.

Contraindications

• Hypersensitivity, metabolic or respiratory alkalosis, hypocalcemia, excessive chloride (Cl-) loss from vomiting or GI suctioning
• Patients at risk of developing diuretic-induced hypochloremic alkalosis
• Hypercarbic acidosis
• Unknown abdominal pain

Effects of Drug Abuse

• No information available

Short-Term Effects

• Somnolence may occur; caution when operating heavy machinery.
• See "What Are Side Effects Associated with Using Sodium Bicarbonate?"

Long-Term Effects

• See "What Are Side Effects Associated with Using Sodium Bicarbonate?"

Cautions

• Not first-line for resuscitation
• Edematous or sodium-retaining states, history of congestive heart failure (CHF), renal impairment, cirrhosis, hypertension, children with diabetic ketoacidosis (DKA), concurrent corticosteroid use
• May cause hypokalemia
• Use caution in patients with cirrhosis, heart failure, renal impairment, peptic ulcer disease, or edema
• Avoid extravasation (may cause chemical cellulitis, tissue necrosis, ulceration, and sloughing due to alkalinity)

Pregnancy and Lactation

• Use sodium bicarbonate with caution during pregnancy if the benefits outweigh the risks. Animal studies show risk and human studies are not available, or neither animal nor human studies were done.
• It is not known if sodium bicarbonate is excreted in breast milk. Consult your doctor before breastfeeding.