Sodium Bicarbonate

Dosage for Sodium Bicarbonate must be highly individualized based on the condition being treated and the patient's acid-base status.

• For Dyspepsia (Antacid): The typical oral dose is 325 mg to 2000 mg (approximately 1/2 teaspoon of powder) taken 1 to 4 times daily. Patients should not exceed the maximum daily dose (usually 16,000 mg for those under 60 years old and 8,000 mg for those over 60) in a 24-hour period.
• For Urinary Alkalinization: The initial dose is often 4 grams, followed by 1 to 2 grams every 4 hours. The goal is typically to maintain a urinary pH above 7.0.
• For Chronic Metabolic Acidosis: Doses range from 1 gram to 4 grams daily, divided into multiple doses, adjusted based on serum bicarbonate levels (target usually 22-28 mEq/L).
• For Cardiac Arrest: In emergency settings, an initial IV dose of 1 mEq/kg is common, followed by 0.5 mEq/kg every 10 minutes depending on arterial blood gas (ABG) results.

Sodium Bicarbonate should be used with extreme caution in children.

• Antacid Use: Not generally recommended for children under 12 years of age unless directed by a pediatrician.
• Metabolic Acidosis: Dosage is calculated based on the 'bicarbonate deficit' formula: 0.3 x weight (kg) x (desired HCO3 - measured HCO3).
• Infants: Rapid injection of hypertonic Sodium Bicarbonate in neonates (under 2 years old) is associated with an increased risk of intraventricular hemorrhage. Solutions should be diluted to 0.5 mEq/mL (4.2%) and administered slowly.

Renal Impairment

Patients with renal impairment are at high risk for sodium retention and metabolic alkalosis. Sodium Bicarbonate should be used with extreme caution in patients with Stage 4 or 5 Chronic Kidney Disease or those on dialysis. Frequent monitoring of serum electrolytes (sodium, potassium, calcium) is mandatory.

Hepatic Impairment

No specific dose adjustments are required for hepatic impairment; however, patients with cirrhosis and ascites are often on sodium-restricted diets. The high sodium content of Sodium Bicarbonate (approx. 274 mg of sodium per 1000 mg of NaHCO3) can exacerbate fluid retention and edema.

Elderly Patients

Patients over 65 years of age should use lower doses. The maximum daily antacid dose is reduced because the elderly are more susceptible to systemic alkalosis and fluid overload. Renal function should be assessed before initiating long-term therapy.

• Oral Tablets: Swallow tablets with a full glass of water. Do not take Sodium Bicarbonate when your stomach is overly full from food or drink, as the CO2 gas produced can cause gastric distension.
• Powder Form: Dissolve the prescribed amount of powder completely in at least 4 ounces (120 mL) of water before drinking.
• Timing: If used as an antacid, take it 1 to 2 hours after meals. If used for other conditions, follow the specific schedule provided by your doctor.
• Storage: Store at room temperature (68°F to 77°F) in a dry place. Keep the container tightly closed to protect from moisture.

If you miss a dose, take it as soon as you remember. If it is almost time for your next dose, skip the missed dose and resume your regular schedule. Do not double the dose to catch up.

Signs of Sodium Bicarbonate overdose include severe headache, nausea, vomiting, irritability, muscle weakness, and swelling of the feet or lower legs. In severe cases, it can lead to metabolic alkalosis, characterized by tetany (muscle spasms), seizures, and cardiac arrhythmias. If an overdose is suspected, contact a Poison Control Center or seek emergency medical attention immediately.

> Important: Follow your healthcare provider's dosing instructions exactly. Do not adjust your dose or stop taking this medication without medical guidance, as it can cause a rebound effect in stomach acid or a dangerous shift in blood pH.

When used as an antacid or for short-term buffering, the most common side effects are related to the chemical reaction in the stomach:

• Belching and Flatulence: The reaction between Sodium Bicarbonate and stomach acid produces carbon dioxide gas. This often leads to significant burping or gas shortly after administration.
• Gastric Distension: A feeling of fullness or bloating in the upper abdomen caused by gas production.
• Mild Nausea: Some patients find the salty, alkaline taste of the solution unpleasant, which can lead to transient queasiness.

• Stomach Cramps: Occasional localized discomfort as the stomach processes the gas and neutralized contents.
• Increased Thirst: Due to the high sodium content, patients may experience dry mouth and an increased urge to drink fluids.
• Mild Edema: Slight swelling in the ankles or fingers, particularly in patients sensitive to salt intake.

• Gastric Rupture: This is a rare but life-threatening complication. It typically occurs when Sodium Bicarbonate is taken on an extremely full stomach (after a large meal). The rapid evolution of CO2 gas can cause the stomach wall to tear.
• Milk-Alkali Syndrome: Occurs when Sodium Bicarbonate is taken with large amounts of calcium (e.g., dairy products or calcium supplements). Symptoms include high blood calcium, kidney stones, and renal failure.
• Hypokalemia: Excessive bicarbonate can cause potassium to shift from the blood into the cells, leading to low blood potassium levels.

> Warning: Stop taking Sodium Bicarbonate and call your doctor immediately if you experience any of these symptoms:

• Signs of Metabolic Alkalosis: Severe confusion, muscle twitching or tremors, irritability, and prolonged vomiting. This indicates the blood has become too alkaline.
• Severe Hypernatremia: Extreme thirst, restlessness, and rapid heartbeat, indicating dangerously high sodium levels.
• Hypocalcemic Tetany: Muscle cramps, spasms in the hands or feet, or a tingling sensation around the mouth, caused by a drop in ionized calcium levels.
• Congestive Heart Failure Exacerbation: Sudden shortness of breath, rapid weight gain (more than 2-3 pounds in a day), and severe swelling in the legs.
• Seizures: Any new onset of neurological activity requires emergency intervention.

Chronic use of Sodium Bicarbonate can lead to several complications:

• Renal Calculi: Long-term alkalinization of the urine can, in some cases, promote the formation of calcium phosphate stones.
• Acid Rebound: The stomach may respond to the neutralization of acid by producing even more acid once the bicarbonate has cleared, leading to a cycle of dependency.
• Systemic Alkalosis: Continuous ingestion can overwhelm the kidneys' ability to excrete bicarbonate, leading to a chronic state of high blood pH that affects multiple organ systems.
• Bone Demineralization: While sometimes used to protect bones in CKD, inappropriate use can interfere with normal mineral metabolism.

No FDA black box warnings are currently issued for Sodium Bicarbonate. However, it is considered a high-alert medication in intravenous form due to the risk of severe electrolyte shifts and tissue necrosis if extravasation (leaking into surrounding tissue) occurs during injection.

Report any unusual symptoms to your healthcare provider. Monitoring of blood chemistry is essential for anyone using this medication on a long-term basis.

Sodium Bicarbonate is a potent chemical agent that affects the body's acid-base balance and electrolyte status. It should never be viewed as 'just baking soda' when used for medical purposes. Patients must be aware that this medication contains significant amounts of sodium, which can negatively impact blood pressure and fluid balance. It is not intended for long-term use as an antacid (more than 2 weeks) unless specifically directed by a physician for a chronic condition like kidney disease.

There are no FDA black box warnings for Sodium Bicarbonate. It is generally recognized as safe (GRAS) when used according to standard medical guidelines, though its use in emergency IV settings is strictly controlled.

• Allergic Reactions: While rare, hypersensitivity to Sodium Bicarbonate or any inactive ingredients in the tablets can occur. Seek help if you experience hives, difficulty breathing, or swelling of the face.
• Cardiovascular Risk: Because of its high sodium content, Sodium Bicarbonate can cause the body to retain water. This is extremely dangerous for patients with hypertension (high blood pressure) or Congestive Heart Failure (CHF). It can trigger a 'flare' or exacerbation of heart failure symptoms.
• Renal Toxicity: In patients with pre-existing kidney disease, the inability to excrete the sodium and bicarbonate load can lead to rapid-onset renal failure or the development of kidney stones.
• Gastrointestinal Warning: Do not take this medication when the stomach is overly full. The rapid production of gas has been clinically documented to cause gastric perforation (a hole in the stomach), which is a surgical emergency.
• Electrolyte Imbalance: Sodium Bicarbonate can lower potassium and calcium levels in the blood. This can lead to heart rhythm problems or muscle dysfunction.

If you are taking Sodium Bicarbonate for more than a few days, your healthcare provider will likely require regular blood tests, including:

• Serum Electrolytes: To monitor sodium, potassium, chloride, and calcium levels.
• Arterial or Venous Blood Gases: To check the pH and bicarbonate levels in the blood.
• Renal Function Tests: Creatinine and BUN levels to ensure the kidneys are handling the medication safely.
• Urinary pH: If the medication is being used to alkalinize the urine.

Sodium Bicarbonate typically does not cause drowsiness or impair cognitive function. However, if you experience side effects like confusion or muscle twitching due to alkalosis, you should avoid driving and contact your doctor immediately.

Alcohol should be avoided or strictly limited while taking Sodium Bicarbonate. Alcohol can increase gastric acid production, worsening the condition being treated, and may also contribute to dehydration and electrolyte imbalances.

Do not stop taking Sodium Bicarbonate suddenly if you are using it for a chronic condition like metabolic acidosis. Sudden discontinuation can cause your blood pH to drop rapidly (rebound acidosis). Your doctor will provide a tapering schedule if the medication needs to be stopped.

> Important: Discuss all your medical conditions, especially heart or kidney problems, with your healthcare provider before starting Sodium Bicarbonate.

Sodium Bicarbonate should not be used concurrently with certain medications due to the risk of severe adverse effects:

• Enteric-Coated Medications: Sodium Bicarbonate raises gastric pH, which can cause enteric-coated tablets to dissolve prematurely in the stomach rather than the intestines. This can lead to stomach irritation or reduced drug efficacy.
• Calcium Supplements (High Dose): Using high doses of calcium with Sodium Bicarbonate can lead to Milk-Alkali Syndrome, resulting in permanent kidney damage.

• Salicylates (Aspirin): Sodium Bicarbonate increases the renal excretion of salicylates. While this is used to treat aspirin overdose, it can reduce the effectiveness of aspirin when used for pain or heart protection.
• Quinidine: Alkalinization of the urine decreases the renal clearance of quinidine, potentially leading to toxic levels of this heart medication.
• Amphetamines: Similar to quinidine, amphetamines are excreted more slowly in alkaline urine, which can increase their stimulatory effects and toxicity risk.
• Lithium: Sodium Bicarbonate may increase the excretion of lithium, potentially lowering its blood levels and reducing its effectiveness in treating bipolar disorder.

• Ketoconazole and Itraconazole: These antifungal medications require an acidic environment in the stomach to be absorbed. Sodium Bicarbonate can significantly reduce their absorption and efficacy.
• Iron Supplements: Iron is best absorbed in an acidic environment. Taking Sodium Bicarbonate can reduce the amount of iron the body absorbs.
• Tetracycline Antibiotics: Sodium Bicarbonate can interfere with the absorption of tetracyclines. These medications should be taken at least 2 hours before or after Sodium Bicarbonate.

• Dairy Products: Large amounts of milk or cheese taken with Sodium Bicarbonate can increase the risk of hypercalcemia (high blood calcium).
• High-Sodium Foods: Since the medication is high in sodium, patients should avoid high-salt diets to prevent fluid retention and high blood pressure.

• Citrus Fruits/Vitamin C: Large amounts of Vitamin C can acidify the urine, counteracting the effects of Sodium Bicarbonate if it is being used for urinary alkalinization.
• Herbal Antacids: Using other herbal remedies for heartburn (like slippery elm or licorice) may have additive effects or interfere with the absorption of Sodium Bicarbonate.

Sodium Bicarbonate can affect the results of several laboratory tests:

• Gastric Acid Secretion Tests: It will neutralize the acid, making the test inaccurate.
• Blood pH and CO2: These are expected to change, but the medication can mask underlying respiratory or metabolic issues.
• Urine pH: Will be elevated, which can affect the interpretation of urinalysis results (e.g., protein or bacteria detection).

For each major interaction, the mechanism usually involves either a change in gastric pH affecting absorption or a change in urinary pH affecting excretion. Management typically involves spacing the doses of the two medications by at least 2 to 4 hours.

> Important: Tell your doctor about ALL medications, supplements, and herbal products you are taking to prevent dangerous interactions.

Sodium Bicarbonate must NEVER be used in the following circumstances:

• Metabolic or Respiratory Alkalosis: If the body's pH is already too high, adding an alkalinizing agent can lead to life-threatening complications, including respiratory failure and seizures.
• Hypocalcemia: Lowering the acidity of the blood further reduces the amount of 'ionized' (active) calcium available, which can trigger severe muscle spasms and heart rhythm disturbances.
• Severe Chloride Depletion: Often caused by prolonged vomiting or gastric suctioning. In these cases, the body needs chloride, not bicarbonate, to correct the pH.
• Hypersensitivity: Known allergy to Sodium Bicarbonate or any component of the formulation.
• Abdominal Pain of Unknown Origin: Taking an antacid like Sodium Bicarbonate could mask symptoms of a serious condition like appendicitis or a bowel obstruction.

Conditions requiring a careful risk-benefit analysis by a physician include:

• Congestive Heart Failure (CHF): The sodium load can cause fluid volume overload.
• Severe Renal Insufficiency: Risk of sodium retention and inability to regulate bicarbonate levels.
• Hypertension: The salt content can cause blood pressure to spike.
• Edematous States: Conditions like cirrhosis or nephrotic syndrome where the body is already retaining fluid.

There is no known cross-sensitivity between Sodium Bicarbonate and other drug classes. However, patients who react poorly to other sodium-based salts or alkaline substances should be monitored closely.

> Important: Your healthcare provider will evaluate your complete medical history, including your current electrolyte levels and kidney function, before prescribing Sodium Bicarbonate.

Sodium Bicarbonate is classified as FDA Pregnancy Category C. This means that animal reproduction studies have not been conducted, and it is not known whether Sodium Bicarbonate can cause fetal harm when administered to a pregnant woman. However, its use during pregnancy is generally discouraged for minor indigestion because the high sodium content can lead to fluid retention (edema) in the mother. In cases of severe metabolic acidosis, the benefits may outweigh the risks, but this must be managed in a hospital setting. There is no known teratogenicity (birth defect risk) data, but metabolic shifts in the mother can affect the fetus.

It is not known whether Sodium Bicarbonate is excreted in human milk. However, since bicarbonate and sodium are normal constituents of the body, it is unlikely to have a negative effect on a nursing infant when used in standard, short-term doses. Long-term use or high doses should be avoided by breastfeeding mothers unless directed by a physician, as it could theoretically alter the electrolyte balance of the milk.

Sodium Bicarbonate is not approved for self-medication (OTC use) in children under 12. In clinical settings, it is used for metabolic acidosis, but with extreme caution. In neonates and infants, rapid IV administration of hypertonic Sodium Bicarbonate can cause a sudden shift in osmolality, leading to intracranial hemorrhage (bleeding in the brain). Growth effects from long-term use in children have not been extensively studied, but chronic alkalosis can interfere with normal mineral deposition in bones.

Patients over the age of 65 are at a significantly higher risk for adverse effects. Aging kidneys are less efficient at excreting excess sodium and bicarbonate, making these patients more prone to systemic alkalosis and fluid overload. Geriatric patients are also more likely to be taking concurrent medications (polypharmacy) that interact with Sodium Bicarbonate, such as diuretics or blood pressure medications. Fall risk may increase if the medication causes electrolyte imbalances leading to muscle weakness or confusion.

In patients with a Glomerular Filtration Rate (GFR) below 30 mL/min, the use of Sodium Bicarbonate requires intense monitoring. While it is used therapeutically in CKD to buffer metabolic acid, the risk of 'overshooting' into alkalosis is high. It is not typically cleared by dialysis in a way that allows for rapid correction of an overdose; rather, the dialysate itself is adjusted to manage the patient's bicarbonate levels.

No specific dose adjustments are required for patients with liver disease. However, those with Child-Pugh Class B or C cirrhosis often have significant sodium restrictions to manage ascites. For these patients, even a few grams of Sodium Bicarbonate can represent a dangerous amount of 'hidden' salt.

> Important: Special populations require individualized medical assessment and frequent lab monitoring to ensure safety.

Sodium Bicarbonate acts as a systemic and urinary alkalinizer. After oral or parenteral administration, it increases the concentration of bicarbonate ions (HCO3-) in the plasma. Bicarbonate is the primary buffer in the extracellular fluid of the human body. It reacts with hydrogen ions (H+) to form carbonic acid (H2CO3), which is then rapidly converted by the enzyme carbonic anhydrase into water (H2O) and carbon dioxide (CO2). The CO2 is subsequently eliminated via the lungs. By consuming hydrogen ions, Sodium Bicarbonate effectively raises the pH of the blood and other body fluids.

• Onset of Action: When taken orally as an antacid, the onset is rapid (within minutes) but the duration is short (30-60 minutes). When given IV for acidosis, the effect on blood pH is almost immediate.
• Duration of Effect: The duration depends on the renal function of the patient and the underlying cause of the acid-base imbalance. In healthy individuals, excess bicarbonate is excreted within 3-4 hours.
• Tolerance: There is no evidence of pharmacological tolerance, but 'acid rebound' can occur where the stomach produces more acid in response to the neutralized environment.

| Parameter | Value |

|---|---|

| Bioavailability | Rapidly absorbed (Oral) |

| Protein Binding | Negligible |

| Half-life | Variable (Excreted as CO2 and via kidneys) |

| Tmax | 0.5 - 2 hours (Oral) |

| Metabolism | None (Dissociates into ions) |

| Excretion | Renal (Bicarbonate); Pulmonary (CO2) |

• Molecular Formula: NaHCO3
• Molecular Weight: 84.007 g/mol
• Solubility: Soluble in water (96 g/L at 20°C); insoluble in ethanol.
• Description: A white, crystalline powder or granules with a slight alkaline taste.

Sodium Bicarbonate is categorized as an Alkalinizing Agent. Within the gastrointestinal context, it is a Systemic Antacid. It is distinct from non-systemic antacids like aluminum hydroxide, which are not absorbed into the bloodstream. In the context of combination products, it may be listed under Proton Pump Inhibitor [EPC] due to its role in stabilizing drugs like omeprazole.