Sodium Bicarbonate

Pronunciation: (SO-dee-uhm by-CAR-boe-nate)Class: Urinary alkalinizer, System alkalinizer, Electrolyte, Antacid

Trade Names:Bell/ans- Tablets 520 mg

Trade Names:Neut- Neutralizing additive solution 4% (0.48 mEq/mL)

Trade Names:Sodium Bicarbonate- Injection 4.2% (0.5 mEq/mL)- Injection 5% (0.6 mEq/mL)- Injection 7.5% (0.9 mEq/mL)- Injection 8.4% (1 mEq/mL)- Neutralizing additive solution 4.2% (0.5 mEq/mL)- Powder 120 g- Tablets 325 mg- Tablets 650 mg

Pharmacology

Increases plasma bicarbonate; buffers excess hydrogen ion concentrations; raises blood pH; reverses metabolic acidosis.

Indications and Usage

Treatment of metabolic acidosis; promotion of gastric, systemic, and urinary alkalinization; replacement therapy in severe diarrhea; used to reduce incidence of chemical phlebitis (used as neutralizing additive solution).

Contraindications

Loss of chloride from vomiting or continuous GI suction when patient is receiving diuretics known to produce hypochloremic alkalosis; metabolic and respiratory alkalosis; hypocalcemia in which alkalosis may produce tetany, hypertension, convulsions, or CHF; when administration of sodium could be clinically detrimental.

Dosage and Administration

Adults and Children older than 2 yr of age

IV Administration performed in concentrations ranging from 1.5% (isotonic) to 8.4% depending on clinical condition and requirements of patient.

Subcutaneous After dilution to isotonicity (1.5%). The dose depends on the clinical condition and requirements of the patient (including age and weight).

PO 325 mg to 2 g 1 to 4 times daily (patients younger than 60 yr of age, max dose 16 g/day; patients older than 60 yr of age max dose 8 g/day).

Infants up to 2 yr of age

IV 4.2% solution at rate up to 8 mEq/kg/day.

Drug Interactions

Amphetamine, dextroamphetamine, ephedrine, flecainide, mecamylamine, methamphetamine, pseudoephedrine, quinidine

Sodium bicarbonate can decrease elimination of these drugs, thus increasing their therapeutic effects.

Chlorpropamide, lithium, methotrexate, salicylates, tetracyclines

Sodium bicarbonate can increase elimination of these drugs, thus decreasing their therapeutic effect.

Ketoconazole

PO sodium bicarbonate may decrease the dissolution of ketoconazole in the GI tract, reducing the effectiveness.

Incompatibility

Do not mix with IV solutions containing catecholamines, such as dobutamine, dopamine, and norepinephrine.

Laboratory Test Interactions

None well documented.

Adverse Reactions

Cardiovascular

Exacerbation of CHF.

GI

Rebound hyperacidity; milk-alkali syndrome.

Lab Tests

Hypernatremia; alkalosis.

Miscellaneous

Extravasation with cellulitis, tissue necrosis, ulceration, and sloughing; local pain; venous irritation; tetany; edema.

Precautions

Pregnancy

Category C .

Lactation

Undetermined.

Children

Newborns and children younger than 2 yr

Administration of at least 10 mL/min of hypertonic sodium bicarbonate may produce hypernatremia, decreased CSF pressure, and possible intracranial hemorrhage.

Special Risk Patients

Use drug with caution in edematous sodium-retaining states, CHF, liver cirrhosis, toxemia of pregnancy, or renal impairment.

Sodium content

May be significant, especially in patients with hypertension or CHF or in patients on low-sodium diets.

Overdosage

Symptoms

Alkalosis, hyperirritability, tetany, nausea, vomiting.

Patient Information

• Instruct patient not to take medication with milk because renali calculi can develop.
• Explain need to avoid OTC medications containing sodium bicarbonate, such as Alka-Seltzer . Excessive use of sodium bicarbonate can result in increase acid secretion or systemic alkalosis.
• Instruct patient not to use max dose of antacids for more than 2 wk except under supervision of health care provider.
• Advise patient not to take sodium bicarbonate on routine or long-term basis. Tell patient to notify health care provider if symptoms of gastric distress continue.
• Caution patient to report these symptoms to health care provider immediately: nausea, vomiting, anorexia.

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