Yes

Alkalinizing Agent; Antacid; Electrolyte Supplement, Oral; Electrolyte Supplement, Parenteral

Management of metabolic acidosis; gastric hyperacidity; as an alkalinization agent for the urine; treatment of hyperkalemia

C

Alkalosis, hypernatremia, severe pulmonary edema, hypocalcemia, unknown abdominal pain

Rapid administration in neonates and children <2 years of age has led to hypernatremia, decreased CSF pressure and intracranial hemorrhage. Use of I.V. NaHCO₃ should be reserved for documented metabolic acidosis and for hyperkalemia-induced cardiac arrest. Routine use in cardiac arrest is not recommended. Avoid extravasation, tissue necrosis can occur due to the hypertonicity of NaHCO₃. May cause sodium retention especially if renal function is impaired; not to be used in treatment of peptic ulcer; use with caution in patients with CHF, edema, cirrhosis, or renal failure. Not the antacid of choice for the elderly because of sodium content and potential for systemic alkalosis.

Percentage unknown: Edema, cerebral hemorrhage, aggravation of congestive heart failure, tetany, intracranial acidosis, metabolic alkalosis, hypernatremia, hypokalemia, hypocalcemia, hyperosmolality, belching, gastric distension, flatulence (with oral), pulmonary edema, increased affinity of hemoglobin for oxygen-reduced pH in myocardial tissue necrosis when extravasated; milk alkali syndrome (especially with renal dysfunction)

Symptoms of overdose include hypocalcemia, hypokalemia, hypernatremia, seizures

Seizures can be treated with diazepam 0.1-0.25 mg/kg; hypernatremia is resolved through the use of diuretics and free water replacement

Decreased effect/levels of lithium, chlorpropamide, methotrexate, tetracyclines, and salicylates due to urinary alkalinization

Increased toxicity/levels of amphetamines, anorexiants, mecamylamine, ephedrine, pseudoephedrine, flecainide, quinidine, quinine due to urinary alkalinization

Store injection at room temperature; protect from heat and from freezing; use only clear solutions; Advise patient of milk-alkali syndrome if use is long-term; observe for extravasation when giving I.V.; incompatible with acids, acidic salts, alkaloid salts, atropine, calcium salts, catecholamines

Dissociates to provide bicarbonate ion which neutralizes hydrogen ion concentration and raises blood and urinary pH

Oral: Onset of action: Rapid; Duration: 8-10 minutes

I.V.: Onset of action: 15 minutes; Duration: 1-2 hours

Absorption: Oral: Well absorbed

Elimination: Reabsorbed by kidney and <1% is excreted by urine

Cardiac arrest: Routine use of NaHCO₃ is not recommended and should be given only after adequate alveolar ventilation has been established and effective cardiac compressions are provided

Infants and Children: I.V.: 0.5-1 mEq/kg/dose repeated every 10 minutes or as indicated by arterial blood gases; rate of infusion should not exceed 10 mEq/minute; neonates and children <2 years of age should receive 4.2% (0.5 mEq/mL) solution

Adults: I.V.: Initial: 1 mEq/kg/dose one time; maintenance: 0.5 mEq/kg/dose every 10 minutes or as indicated by arterial blood gases

Metabolic acidosis: Dosage should be based on the following formula if blood gases and pH measurements are available:

Infants and Children:

HCO₃^-(mEq) = 0.3 x weight (kg) x base deficit (mEq/L) or

HCO₃^-(mEq) = 0.5 x weight (kg) x [24 - serum HCO₃^- (mEq/L)]

Adults:

HCO₃^-(mEq) = 0.2 x weight (kg) x base deficit (mEq/L) or

HCO₃^-(mEq) = 0.5 x weight (kg) x [24 - serum HCO₃^- (mEq/L)]

If acid-base status is not available: Dose for older Children and Adults: 2-5 mEq/kg I.V. infusion over 4-8 hours; subsequent doses should be based on patient's acid-base status

Chronic renal failure: Oral: Initiate when plasma HCO₃^- <15 mEq/L

Children: 1-3 mEq/kg/day

Adults: Start with 20-36 mEq/day in divided doses, titrate to bicarbonate level of 18-20 mEq/L

Renal tubular acidosis: Oral:

Distal:

Children: 2-3 mEq/kg/day

Adults: 0.5-2 mEq/kg/day in 4-5 divided doses

Proximal: Children: Initial: 5-10 mEq/kg/day; maintenance: Increase as required to maintain serum bicarbonate in the normal range

Urine alkalinization: Oral:

Children: 1-10 mEq (84-840 mg)/kg/day in divided doses every 4-6 hours; dose should be titrated to desired urinary pH

Adults: Initial: 48 mEq (4 g), then 12-24 mEq (1-2 g) every 4 hours; dose should be titrated to desired urinary pH; doses up to 16 g/day (200 mEq) in patients <60 years and 8 g (100 mEq) in patients >60 years

Antacid: Adults: Oral: 325 mg to 2 g 1-4 times/day

Oral product should be administered 1-3 hours after meals; concurrent doses with iron may decrease iron absorption

For I.V. administration to infants, use the 0.5 mEq/mL solution or dilute the 1 mEq/mL solution 1:1 with sterile water; for direct I.V. infusion in emergencies, give slowly (maximum rate in infants: 10 mEq/minute); for infusion, dilute to a maximum concentration of 0.5 mEq/mL in dextrose solution and infuse over 2 hours (maximum rate of administration: 1 mEq/kg/hour)

None reported

May decrease serum lithium levels due to increased clearance but overall effect is minimal; does not offer much benefit in lithium overdose; if lithium toxicity is severe, dialysis is the treatment of choice

No information available to require special precautions

No effects or complications reported

Do not use for chronic gastric acidity. Take as directed. Chew tablets thoroughly and follow with a full glass of water, preferably on an empty stomach (2 hours before or after food). Take at least 2 hours before or after any other medications. Report CNS effects (eg, irritability, confusion); muscle rigidity or tremors; swelling of feet or ankles; difficulty breathing; chest pain or palpitations; respiratory changes; or tarry stools. Pregnancy precautions: Inform prescriber if you are or intend to be pregnant.

Advise patient of milk-alkali syndrome if use is long-term; observe for extravasation when giving I.V.

Injection: 4% [40 mg/mL = 2.4 mEq/5 mL] (5 mL); 4.2% [42 mg/mL = 5 mEq/10 mL] (10 mL); 7.5% [75 mg/mL = 8.92 mEq/10 mL] (10 mL, 50 mL); 8.4% [84 mg/mL = 10 mEq/10 mL] (10 mL, 50 mL)

Powder: 120 g, 480 g

Tablet: 300 mg [3.6 mEq]; 325 mg [3.8 mEq]; 520 mg [6.3 mEq]; 600 mg [7.3 mEq]; 650 mg [7.6 mEq]

Del Beccaro MA and Robertson WO, "Baking Soda Poisoning," Vet Hum Toxicol, 1988, 30(2):164-5.

Levin T, "What This Patient Didn't Need: A Dose of Salts," Hosp Pract (Off Ed), 1983, 18(7):95-8.

Linford SM and James HD, "Sodium Bicarbonate Abuse: A Case Report," Br J Psychiatry, 1986, 149:502-3.

Narins RG and Cohen JJ, "Bicarbonate Therapy for Organic Acidosis: The Case for Its Continued Use," Ann Intern Med, 1987, 106(4):615-8.

Nichols MH, Wason S, Gonzalez Del Rey J, et al, "Baking Soda: A Potentially Fatal Home Remedy," Pediatr Emerg Care, 1995, 11(2):109-11.

Stork CM, Redd JT, Fine K, et al, "Propoxyphene-Induced Wide QRS Complex Dysrhythmia Responsive to Sodium Bicarbonate - A Case Report," J Toxicol Clin Toxicol, 1995, 33(2):179-83.