sodium bicarbonate (NaHCO3)

Indications

• renal tubular acidosis (RTA) type 1: 1-2 meq/kg/day
• cocaine-induced ventricular dysrhythmias
• severe acidemia
• hyperkalemia
• symptomatic treatment of dyspepsia, GERD & peptic ulcer disease
• alkalinization of the urine in certain drug intoxications
  • acetaminophen toxicity
  • lithium toxicity
  • salicylate toxicity

Contraindications

pregnancy-category :value C

safety-in-lactation :value ?

Dosage

• oral: 1-6 tabs 1-4 times/day as needed
• intravenous (IV) drip:
  • mix 3 or 3/12 amps in 1 L of D5W
    • 118 meq/L or 135 meq/L
  • infuse at 50 mL/hr

1 amp of bicarbonate = 44.5 meq (8.4%).

Tabs: 650 mg.

Injection: 4.2% (0.5 meq/L) 10 mL 7.5% (0.9 meq/L) 50 mL vial & 50 mL syringe 8.4% (1 meq/mL) 50 mL

Pharmacokinetics

• duration of action for GI tract alkalinization is 30-60 minutes, but may be as long as 3 hours when given after meals
• elimination :route kidney

Adverse effects

(excessive administration)

• oral administration
  • gastric distension
  • flatulence
  • milk-alkali syndrome
  • rebound hyperacidity
• systemic effects
  • metabolic alkalosis
  • seizures
  • tetany
  • hypocalcemia
  • cardiac arrhythmias
  • hypokalemia
  • hypernatremia
  • increased lactate production
  • intracranial acidosis*
  • cerebral hemorrhage
  • edema
  • increased affinity of hemoglobin for O2
• extravasation of IV can cause chemical cellulitis

* No proven clinical consequences.

Drug interactions

decreased absorption of many medications

Mechanism of action

alkalinization of the blood &/or GI tract

More general terms

• salt
• metabolic agent (metabolic modifier)

Additional terms

• bicarbonate/carbonate (Carbicarb)
• HCO3- (bicarbonate)
• Na+

Component of

• sodium bicarbonate/suppository
• magnesium sulfate/polyethylene glycol/potassium chloride/potassium sulfate/sodium bicarbonate/sodium chloride
• aspirin/bromadiolone/citrate/sodium bicarbonate
• sodium bicarbonate/tartaric acid
• sodium bicarbonate/sodium chloride/sodium phosphate
• pancreatin/potassium bicarbonate/sodium bicarbonate
• magnesium sulfate/polyethylene glycol/potassium chloride/sodium bicarbonate/sodium chloride
• magnesium hydroxide/omeprazole/sodium bicarbonate
• magnesium chloride/sodium bicarbonate/sodium chloride
• magnesium carbonate/sodium bicarbonate
• calcium chloride/glucose/magnesium sulfate/potassium chloride/sodium bicarbonate/sodium chloride/sodium phosphate
• calcium chloride/glucose/magnesium chloride/potassium chloride/sodium bicarbonate/sodium chloride/sodium phosphate
• calcium carbonate/sodium bicarbonate
• bisacodyl/polyethylene glycol/potassium chloride/sodium bicarbonate/sodium chloride
• potassium bitartrate/sodium bicarbonate
• hco3 /polyethylene glycol/potassium chloride/sodium bicarbonate/sodium chloride/sodium sulfate
• polyethylene glycol/potassium chloride/sodium bicarbonate/sodium chloride
• omeprazole/sodium bicarbonate
• citrate/sodium bicarbonate
• citrate/potassium bicarbonate/sodium bicarbonate
• aspirin/citrate/sodium bicarbonate
• aspirin/citric acid/sodium bicarbonate (Alka-Seltzer)
• Elliotts B Solution (buffered intrathecal electrolyte/dextrose injection)

Database

• PubChem: http://pubchem.ncbi.nlm.nih.gov/summary/summary.cgi?cid=516892