sodium bicarbonate

REMS

PO: IV: Management of metabolic acidosis.
PO: IV: Used to alkalinize urine and promote excretion of certain drugs in overdosage situations (phenobarbital, aspirin).
PO: Antacid.

Unlabeled Use:

Stabilization of acid-base status in cardiac arrest and treatment of life-threatening hyperkalemia.

Action ⬆ ⬇

Acts as an alkalinizing agent by releasing bicarbonate ions.
Following oral administration, releases bicarbonate, which is capable of neutralizing gastric acid.

Therapeutic effects:

Alkalinization.
Neutralization of gastric acid.

Pharmacokinetics ⬆ ⬇

Absorption: Following oral administration, excess bicarbonate is absorbed and results in metabolic alkalosis and alkaline urine. IV administration results in complete bioavailability.

Distribution: Widely distributed into extracellular fluid.

Metabolism/Excretion: Sodium and bicarbonate are excreted by the kidneys.

Half-Life: Unknown.

Time/Action Profile ⬆ ⬇

(PO = antacid effect; IV = alkalinization)

ROUTE	ONSET	PEAK	DURATION
PO	immediate	30 min	1–3 hr
IV	immediate	rapid	unknown

Contraind./Precautions ⬆ ⬇

Contraindicated in:

Metabolic or respiratory alkalosis;
Hypocalcemia;
Hypernatremia;
Excessive chloride loss;
As an antidote following ingestion of strong mineral acids;
Patients on sodium-restricted diets (oral use as an antacid only);
Renal failure (oral use as an antacid only);
Severe abdominal pain of unknown cause, especially if associated with fever (oral use as an antacid only).

Use Cautiously in:

HF;
Renal impairment;
Concurrent corticosteroid therapy;
Chronic use as an antacid (may cause metabolic alkalosis and possible sodium overload);
Pedi: May risk of cerebral edema in children with diabetic ketoacidosis.

Adv. Reactions/Side Effects ⬆ ⬇

CV: edema

F and E: metabolic alkalosis, hypernatremia, hypocalcemia, hypokalemia

GI:

flatulence, gastric distention

Local: irritation at IV site

Neuro: cerebral hemorrhage (with rapid injection in infants), tetany

Interactions ⬆ ⬇

Drug-drug:

Following oral administration, may ↓ absorption of ketoconazole.
Concurrent use with calcium-containing antacids may lead to milk-alkali syndrome.
Urinary alkalinization may result in ↓ salicylate or barbiturate blood levels; ↑ blood levels of quinidine, mexiletine, flecainide, or amphetamines; ↑ risk of crystalluria from fluoroquinolones; ↓ effectiveness of methenamine.
May negate the protective effects of enteric-coated products (do not administer within 1–2 hr of each other).

Route/Dosage ⬆ ⬇

Contains 12 mEq of sodium/g

Alkalinization of Urine

PO (Adults ): 48 mEq (4 g) initially, then 12–24 mEq (1–2 g) every 4 hr (up to 48 mEq every 4 hr) or 1 tsp of powder every 4 hr as needed.
PO (Children ): 1–10 mEq/kg/day (84–840 mg/kg/day) in divided doses.
IV (Adults and Children ): 2–5 mEq/kg as a 4–8-hr infusion.

Antacid

PO (Adults ): Tablets/powder: 325 mg–2 g 1–4 times daily or ½ tsp every 2 hr as needed. Effervescent powder: 3.9–10 g in water after meals; patients >60 yr should receive 1.9–3.9 g after meals.

Systemic Alkalinization/Cardiac Arrest

IV (Adults and Children and Infants): Cardiac arrest/urgent situations: 1 mEq/kg; may repeat 0.5 mEq/kg every 10 min. Less urgent situations: 2–5 mEq/kg as a 4–8-hr infusion.

Renal Tubular Acidosis

PO (Adults ): 0.5–2 mEq/kg/day in 4–5 divided doses.
PO (Children ): 2–3 mEq/kg/day in 3–4 divided doses.

Availability ⬆ ⬇

(Generic available)

Oral powder: (20.9 mEq Na/½ tsp) in 120-, 240-, 480-, and 2400-g containers^OTC
Tablets: 325 mg (3.9 mEq Na/tablet)^OTC; 500 mg (6.0 mEq Na/tablet^OTC; 650 mg (7.7 mEq Na/tablet)^OTC
Solution for injection: 4.2% (0.5 mEq/mL); 8.4% (1 mEq/mL)

Assessment ⬆ ⬇

IV: Assess fluid balance (intake and output, daily weight, edema, lung sounds) throughout therapy. Report symptoms of fluid overload (hypertension, edema, dyspnea, rales/crackles, frothy sputum) if they occur.
- Assess patient for signs of acidosis (disorientation, headache, weakness, dyspnea, hyperventilation), alkalosis (confusion, irritability, paresthesia, tetany, altered breathing pattern), hypernatremia (edema, weight gain, hypertension, tachycardia, fever, flushed skin, mental irritability), or hypokalemia (weakness, fatigue, U wave on ECG, arrhythmias, polyuria, polydipsia) throughout therapy.
- Observe IV site closely. Avoid extravasation, as tissue irritation or cellulitis may occur. If infiltration occurs, confer with physician or other health care professional regarding warm compresses and infiltration of site with lidocaine or hyaluronidase.
Antacid: Assess patient for epigastric or abdominal pain and frank or occult blood in the stool, emesis, or gastric aspirate.

Lab Test Considerations:

Monitor serum sodium, potassium, calcium, bicarbonate concentrations, serum osmolarity, acid-base balance, and renal function prior to and periodically throughout therapy.
- Obtain arterial blood gases frequently in emergency situations and during parenteral therapy.
- Monitor urine pH frequently when used for urinary alkalinization.
- Antagonizes effects of pentagastrin and histamine during gastric acid secretion test. Avoid administration during the 24 hr preceding the test.

Implementation ⬆ ⬇

This medication may cause premature dissolution of enteric-coated tablets in the stomach.
PO: Tablets must be taken with a full glass of water.
- When used in treatment of peptic ulcers, may be administered 1 and 3 hr after meals and at bedtime.

IV Administration:

Used in cardiac arrest or urgent situations.Diluent: Use premeasured ampules or prefilled syringes to ensure accurate dose.
Rate: Administer by rapid bolus. Flush IV line before and after administration to prevent incompatible medications used in arrest management from precipitating.
Diluent: May be diluted in dextrose, saline, and dextrose/saline combinations. Premixed infusions are already diluted and ready to use.
Rate: May be administered over 4–8 hr.

Patient/Family Teaching ⬆ ⬇

Instruct patient to take medication as directed. Take missed doses as soon as remembered unless almost time for next dose.
- Review symptoms of electrolyte imbalance with patients on chronic therapy; instruct patient to notify health care professional if these symptoms occur.
- Advise patient not to take milk products concurrently with this medication. Renal calculi or hypercalcemia (milk-alkali syndrome) may result.
- Emphasize the importance of regular follow-up examinations to monitor serum electrolyte levels and acid-base balance and to monitor progress.
Antacid: Advise patient to avoid routine use of sodium bicarbonate for indigestion. Dyspepsia that persists >2 wk should be evaluated by a health care professional.
- Advise patient on sodium-restricted diet to avoid use of baking soda as a home remedy for indigestion.
- Instruct patient to notify health care professional if indigestion is accompanied by chest pain, difficulty breathing, or diaphoresis or if stools become dark and tarry.

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Pronunciation ⬇

Classifications ⬆ ⬇

Indications ⬆ ⬇