sodium bicarbonate

Action

Restores body's buffering capacity; neutralizes excess acid

Availability

Injection: 4% (2.4 mEq/5 ml), 4.2% (5 mEq/10 ml), 5% (297.5 mEq/500 ml), 7.5% (8.92 mEq/10 ml and 44.6 mEq/50 ml), 8.4% (10 mEq/10 ml and 50 mEq/50 ml)

Oral solution (Citrocarbonate): sodium 30.46 mEq/3.9 g and sodium citrate 1.82 g/3.9 g

Tablets: 325 mg, 650 mg

Indications and dosages

➣ Metabolic acidosis

Adults and children: 2 to 5 mEq/kg by I.V. infusion over 4 to 8 hours. However, dosage highly individualized based on patient's condition and blood pH and carbon dioxide content.

➣ Urinary alkalization

Adults: Initially, 4 g P.O.; then 1 to 2 g P.O. q 4 hours

Children: 1 to 10 mEq/kg/day P.O. in divided doses given q 4 to 6 hours

➣ Renal tubular acidosis

Adults: For distal tubular acidosis, 0.5 to 2 mEq/kg P.O. daily in four to five equal doses. For proximal tubular acidosis, 4 to 10 mEq/kg P.O. daily in divided doses.

➣ Antacid

Adults: 300 mg to 2 g P.O. up to q.i.d., given with a glass of water

Contraindications

• Hypocalcemia

• Metabolic or respiratory alkalosis

• Hypernatremia

• Hypokalemia

• Severe pulmonary edema

• Seizures

• Vomiting resulting in chloride loss

• Diuretic use resulting in hypochloremic alkalosis

• Acute ingestion of mineral acids (with oral form)

Precautions

Use cautiously in:

• renal insufficiency, heart failure, hypertension, peptic ulcer, cirrhosis, toxemia

• pregnant patients.

Administration

• For I.V. use, infuse at prescribed rate using controlled infusion device.

☞ Don't give concurrently with calcium or catecholamines (such as norepinephrine, dobutamine, dopamine). If patient is receiving sodium bicarbonate with any of these drugs, flush I.V. line thoroughly after each dose to prevent contact between drugs.

Adverse reactions

CNS: headache, irritability, confusion, stimulation, tremors, twitching, hyperreflexia, weakness, seizures of alkalosis, tetany

CV: irregular pulse, edema, cardiac arrest

GI: gastric distention, belching, flatulence, acid reflux, paralytic ileus

GU: renal calculi

Metabolic: hypokalemia, fluid retention, hypernatremia, hyperosmolarity (with overdose), metabolic alkalosis Respiratory: slow and shallow respirations, cyanosis, apnea

Other: weight gain, pain and inflammation at I.V. site

Interactions

Drug-drug. Anorexiants, flecainide, mecamylamine, methenamine, quinidine, sympathomimetics: increased urinary alkalization, decreased renal clearance of these drugs

Chlorpropamide, lithium, methotrexate, salicylates, tetracycline: increased renal clearance and decreased efficacy of these drugs

Enteric-coated tablets: premature gastric release of these drugs

Drug-diagnostic tests. Lactate, potassium, sodium: increased levels

Drug-herbs. Oak bark: decreased sodium bicarbonate action

Patient monitoring

☞ When giving I.V., closely monitor arterial blood gas results and electrolyte levels.

☞ Stay alert for signs and symptoms of metabolic alkalosis and electrolyte imbalances.

• Monitor fluid intake and output. Assess for fluid overload.

☞ Avoid rapid infusion, which may cause tetany.

• Watch for inflammation at I.V. site.

Patient teaching

• Tell patient using drug as antacid that too much sodium bicarbonate can cause systemic problems. Urge him to use only the amount approved by prescriber.

• Advise patient not to take oral form with milk. Caution him to avoid the herb oak bark.

• Tell patient sodium bicarbonate interferes with action of many common drugs. Instruct him to notify all prescribers if he's taking oral sodium bicarbonate on a regular basis.

• As appropriate, review all other significant and life-threatening adverse reactions and interactions, especially those related to the drugs, tests, and herbs mentioned above.