sodium bicarbonate

SOE-dee-um bye-KAR-boe-nate

Therapeutic Classification: antiulcer agents

Pharmacologic Classification: alkalinizing agents

REMS

PO: IV: 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.

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.

Absorption: Following oral administration, excess bicarbonate is absorbed, resulting 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.

(PO = antacid effect; IV = alkalinization)

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

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.

CV: edema

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

GI: POflatulence, gastric distention

Local: irritation at IV site

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

Drug-drug:

Following oral administration, may ↓ absorption of ketoconazole.
Calcium-containing antacids may lead to milk-alkali syndrome.
Urinary alkalinization may result in ↓ salicylate or barbiturate 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.

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 teaspoon 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 teaspoon 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.

(Generic available)

Oral powder: (20.9 mEq Na/½ teaspoon) 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)

Assess fluid balance (intake, 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.
Antacid: Assess patient for epigastric or abdominal pain and frank or occult blood in the stool, emesis, or gastric aspirate.

Lab Test Considerations:

Monitor 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.

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:

IV sodium bicarbonate at concentrations ≥4.2% is a vesicant. If extravasation occurs, immediately stop infusion. Leave needle/cannula in place temporarily but do not flush the line. Gently aspirate extravasated solution; then remove needle/cannula. Elevate patient's extremity and apply dry warm compresses. Initiate hyaluronidase antidote for refractory cases in addition to supportive management. For hyaluronidase, inject a total of 1 mL (150 units/mL) intradermally or SUBQ as five separate 0.2-mL injections (using a tuberculin syringe) around the site of extravasation; if IV catheter remains in place, administer IV through the infiltrated catheter; may repeat in 30–60 min if no resolution.
IV Push: 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.
Continuous Infusion: 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.
Y-Site Compatibility:
- acyclovir
- alemtuzumab
- amikacin
- aminophylline
- argatroban
- arsenic trioxide
- ascorbic acid
- atropine
- azithromycin
- aztreonam
- benztropine
- bivalirudin
- bleomycin
- bumetanide
- caffeine citrate
- cangrelor
- carboplatin
- carmustine
- cefazolin
- cefepime
- ceftaroline
- ceftazidime
- ceftobiprole
- ceftolozane/tazobactam
- ceftriaxone
- chloramphenicol
- cisplatin
- cladribine
- clindamycin
- cyanocobalamin
- cyclophosphamide
- cyclosporine
- cytarabine
- dacarbazine
- daptomycin
- daunorubicin
- dexamethasone
- dexmedetomidine
- dexrazoxane
- digoxin
- docetaxel
- enalaprilat
- ephedrine
- epoetin alfa
- eptifibatide
- ertapenem
- erythromycin
- esmolol
- etoposide
- etoposide phosphate
- famotidine
- fentanyl
- filgrastim
- fluconazole
- fludarabine
- fluorouracil
- folic acid
- foscarnet
- fosphenytoin
- furosemide
- gemcitabine
- gemtuzumab ozogamicin
- gentamicin
- glycopyrrolate
- granisetron
- heparin
- hydrocortisone
- ibuprofen lysine
- ifosfamide
- indomethacin
- insulin regular
- irinotecan
- ketorolac
- labetalol
- levofloxacin
- lidocaine
- linezolid
- lorazepam
- magnesium sulfate
- mannitol
- melphalan
- meropenem
- meropenem/vaborbactam
- mesna
- methadone
- methotrexate
- methylprednisolone
- metoclopramide
- metoprolol
- metronidazole
- milrinone
- mitomycin
- mitoxantrone
- morphine
- moxifloxacin
- multivitamins
- nafcillin
- naloxone
- nitroglycerin
- nitroprusside
- octreotide
- oxaliplatin
- oxytocin
- paclitaxel
- palonosetron
- pamidronate
- pantoprazole
- pemetrexed
- penicillin G
- pentobarbital
- phenobarbital
- phentolamine
- phenylephrine
- phytonadione
- piperacillin/tazobactam
- plazomicin
- potassium acetate
- potassium chloride
- procainamide
- propofol
- propranolol
- protamine
- pyridoxine
- remifentanil
- rocuronium
- sodium acetate
- sufentanil
- tacrolimus
- thiotepa
- tigecycline
- tirofiban
- tobramycin
- trastuzumab
- vancomycin
- vasopressin
- vecuronium
- vinblastine
- voriconazole
- zoledronic acid
Y-Site Incompatibility:
- allopurinol
- amiodarone
- amphotericin B deoxycholate
- amphotericin B liposomal
- ampicillin
- anidulafungin
- atracurium
- azathioprine
- buprenorphine
- butorphanol
- calcium chloride
- calcium gluconate
- caspofungin
- cefotaxime
- cefotetan
- cefoxitin
- cefuroxime
- chlorpromazine
- dantrolene
- diazepam
- diazoxide
- dimenhydrinate
- diphenhydramine
- dobutamine
- dopamine
- doxorubicin liposomal
- doxycycline
- epinephrine
- epirubicin
- eravacycline
- ganciclovir
- haloperidol
- idarubicin
- imipenem/cilastatin
- isavuconazonium
- isoproterenol
- ketamine
- leucovorin
- meperidine
- midazolam
- mycophenolate
- nalbuphine
- nicardipine
- norepinephrine
- ondansetron
- papaverine
- pentamidine
- phenytoin
- prochlorperazine
- promethazine
- rituximab
- sargramostim
- succinylcholine
- thiamine
- topotecan
- trimethoprim/sulfamethoxazole
- verapamil
- vincristine
- vinorelbine

Explain the purpose and side effects of sodium bicarbonate. Instruct patient to take medication as directed. Take missed doses as soon as remembered unless almost time for next dose. Advise patient to read Medication Guide before starting and periodically during therapy in case of changes.
Antacid: Advise patient to avoid routine use of sodium bicarbonate for indigestion. Dyspepsia that persists >2 wk should be evaluated by a health care provider.
Emphasize the importance of regular follow-up examinations to monitor serum electrolyte levels and acid-base balance and to monitor progress.
Review symptoms of electrolyte imbalance with patients on chronic therapy; instruct patient to notify health care provider if these symptoms occur.
Advise patient not to take milk products concurrently with this medication. Renal calculi or hypercalcemia (milk-alkali syndrome) may result.
Advise patient on sodium-restricted diet to avoid use of baking soda as a home remedy for indigestion.
Instruct patient to notify health care provider if indigestion is accompanied by chest pain, difficulty breathing, or diaphoresis or if stools become dark and tarry.
Advise patient to notify health care provider of all Rx or OTC medications, vitamins, or herbal products being taken and to consult with health care provider before taking other medications.
Rep: Advise women of reproductive potential to notify health care provider if pregnancy is planned or suspected or if breastfeeding. Frequent use of sodium bicarbonate as an antacid may result in metabolic alkalosis and fluid overload in both mother and fetus.

Increase in urinary pH.
Clinical improvement of acidosis.
Enhanced excretion of selected overdoses and poisonings.
Decreased gastric discomfort.

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Pronunciation ⬇

Classifications ⬆ ⬇

Indications ⬆ ⬇

Action ⬆ ⬇

Pharmacokinetics ⬆ ⬇

Time/Action Profile ⬆ ⬇

Contraind./Precautions ⬆ ⬇

Adv. Reactions/Side Effects ⬆ ⬇

Interactions ⬆ ⬇

Route/Dosage ⬆ ⬇

Availability ⬆ ⬇

Assessment ⬆ ⬇

Implementation ⬆ ⬇

Patient/Family Teaching ⬆ ⬇

Evaluation/Desired Outcomes ⬆