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Sodium BicarbonateGeneric Name:Sodium Bicarbonate
Brand Name:Sodium Bicarbonate
Classifications:gastrointestinal agent; antacid; fluid and electrolyte balance agent
Pregnancy Category:C

Availability
325 mg, 520 mg, 650 mg tablets;  4.2%, 5%, 7.5%, 8.4% injection

Actions
Short-acting, potent systemic antacid. Rapidly neutralizes gastric acid to form sodium chloride, carbon dioxide, and water. After absorption of sodium bicarbonate, plasma alkali reserve is increased and excess sodium and bicarbonate ions are excreted in urine, thus rendering urine less acid. Not suitable for treatment of peptic ulcer because it is short-acting, high in sodium, and may cause, gastric, distention, systemic, alkalosis, and possibly acid-rebound.

Therapeutic effects
Shortacting, potent systemic antacid; rapidly neutralizes gastric acid or systemic acidosis.

Uses   
Systemic alkalinizer to correct metabolic acidosis (as occurs in diabetes mellitus, shock, cardiac arrest, or vascular collapse), to minimize uric acid crystallization associated with uricosuric agents, to increase the solubility of sulfonamides, and to enhance renal excretion of barbiturate and salicylate overdosage. Commonly used as home remedy for relief of occasional heartburn, indigestion, or sour stomach. Used topically as paste, bath, or soak to relieve itching and minor skin irritations such as sunburn, insect bites, prickly heat, poison ivy, sumac, or oak. Sterile solutions are used to buffer acidic parenteral solutions to prevent acidosis. Also as a buffering agent in many commercial products (e.g., mouthwashes, douches, enemas, ophthalmic solutions).

Contraindications
Prolonged therapy with sodium bicarbonate; patients losing chloride (as from vomiting, GI suction, diuresis); heart disease, hypertension; renal insufficiency; peptic ulcer; pregnancy (category C).

Cautious use
Edema, sodium-retaining disorders; lactation; older adults patients.

Route & dosage  
Antacid
Adult:PO 0.3–2 g 1–4 times/d or 1/2 tsp of powder in glass of water

Urinary Alkalinizer
Adult:PO 4 g initially, then 1–2 g q4h
Child:PO 84–840 mg/kg/d in divided doses

Cardiac Arrest
Adult:IV 1 mEq/kg of a 7.5% or 8.4% solution initially, then 0.5 mEq/kg q10min depending on arterial blood gas determinations (8.4% solutions contain 50 mEq/50 mL), give over 1–2 min
Child:IV 0.5–1 mEq/kg of a 4.2% solution q10min depending on arterial blood gas determinations, give over 1–2 min

Metabolic Acidosis
Adult:IV 2–5 mEq/kg by IV infusion over 4–8 h
Infant:IV 2–3 mEq/kg/d of a 4.2% solution over 4–8 h

Administration

Oral

  • Do not add oral preparation to calcium-containing solutions.

Topical

  • Use manufacturer’s directions: Bath or soak, 1/2 cup or more into tub of warm water; Footsoak, 4 tbsp/L(qt) warm water; soak 5–10 min; Paste, 3 parts sodium bicarbonate to 1 part water
  • Note: Solutions in water slowly decompose, decomposition is accelerated by agitating or warming the solution.

Intravenous     


PREPARE IV Infusion: May give 4.2% (0.5 mEq/ml) and 5% (0.595 mEq/ml) NaHCO3 solutions undiluted. Dilute 7.5% (0.892 mEq/ml) and 8.4% (1 mEq/ml) solutions with compatible IV solutions. Dilute to at least 4.2% for infants and children.

ADMINISTER IV Infusion: Give a bolus dose only in emergency situations. Usually, the rate is 2–5 mEq/kg over 4–8 h; do not exceed 50 mEq/h. Stop infusion immediately if extravasation occurs. Severe tissue damage has followed tissue infiltration.


Adverse effects
GI:Belching, gastric distention, flatulence.
Metabolic:Metabolic alkalosis; electrolyte imbalance: sodium overload (pulmonary edema), hypocalcemia (tetany), hypokalemia, milk-alkali syndrome, dehydration.
other:Rapid IV in neonates (Hypernatremia, reduction in CSF pressure, intracranial hemorrhage).
Skin:Severe tissue damage following extravasation of IV solution.
Urogenital:Renal calculi or crystals, impaired kidney function.

Nursing implications  

Assessment & Drug Effects

  • Be aware that long-term use of oral preparation with milk or calcium can cause milk-alkali syndrome: Anorexia, nausea, vomiting, headache, mental confusion, hypercalcemia, hypophosphatemia, soft tissue calcification, renal and ureteral calculi, renal insufficiency, metabolic alkalosis.
  • Lab tests: Urinary alkalinization: Monitor urinary pH as a guide to dosage (pH testing with nitrazine paper may be done at intervals throughout the day and dosage adjustments made accordingly).
  • Lab tests: Metabolic acidosis: Monitor patient closely by observations of clinical condition; measurements of acid-base status (blood pH, Po2, Pco2, Hco3-, and other electrolytes, are usually made several times daily during acute period).
  • Observe for signs of alkalosis (over treatment)
  • Observe for and report S&S of improvement or reversal of metabolic acidosis.

Patient & Family Education

  • Do not use sodium bicarbonate as antacid. A nonabsorbable OTC alternative for repeated use is safer.
  • Do not take antacids longer than 2 wk except under advice and supervision of a physician. Self-medication with routine doses of sodium bicarbonate or soda mints may cause sodium retention and alkalosis, especially when kidney function is impaired.
  • Be aware that commonly used OTC antacid products contain sodium bicarbonate: Alka-Seltzer, Bromo-Seltzer, Gaviscon.
  • Do not breast feed while taking this drug without consulting physician.

 

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