• 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 Uses:

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

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: PO: flatulence, 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.
• 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).

(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);

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.

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

• Alkalinization.
• Neutralization of gastric acid.

Therapeutic Classification: antiulcer agents

Pharmacologic Classification: alkalinizing agents

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.

(PO = antacid effect; IV = alkalinization)

• 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.

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