Sodium Bicarbonate(soe’ dee um)
Parenteral: Neut
Prescription and OTC preparations: Bell/ans
PREGNANCY CATEGORY C (PARENTERAL)
UNKNOWN (ORAL)
Drug Classes
Antacid
Electrolyte
Systemic alkalinizer
Urinary alkalinizer
Therapeutic Actions
Increases plasma bicarbonate; buffers excess hydrogen ion concentration; raises blood pH; reverses the clinical manifestations of acidosis; increases the excretion of free base in the urine, effectively raising the urinary pH; neutralizes or reduces gastric acidity, resulting in an increase in the gastric pH, which inhibits the proteolytic activity of pepsin.
Indications
Treatment of metabolic acidosis, with measures to control the cause of the acidosis
Adjunctive treatment in severe diarrhea with accompanying loss of bicarbonate
Treatment of certain drug intoxications, hemolytic reactions that require alkalinization of the urine; prevention of methotrexate nephrotoxicity by alkalinization of the urine
Minimization of uric acid crystalluria in gout, with uricosuric agents
Minimization of sulfonamide crystalluria
Oral: Symptomatic relief of upset stomach from hyperacidity associated with peptic ulcer, gastritis, peptic esophagitis, gastric hyperacidity, hiatal hernia
Oral: Prophylaxis of GI bleeding, stress ulcers, aspiration pneumonia
To reduce the incidence of chemical phlebitis and patient discomfort due to vein irritation at or near the infusion site by raising the pH of IV acid solutions
Contraindications and Cautions
Contraindicated with allergy to components of preparations; low serum chloride (secondary to vomiting, continuous GI suction, diuretics associated with hypochloremic alkalosis); metabolic and respiratory alkalosis; hypocalcemia (alkalosis may precipitate tetany).
Use cautiously with impaired renal function, HF, edematous or sodium-retaining states, oliguria or anuria, potassium depletion (may predispose to metabolic alkalosis), pregnancy, lactation.
Available Forms
Injection—0.9, 1.0 mEq/mL; neutralizing additive solution—0.48, 0.5 mEq/mL; tablets—325, 650 mg
Dosages
Adults
Urinary alkalinization: Initially, 3,900 mg PO; then 1,300–2,600 mg every 4 hr. Up to 16 g/day has been used.
Antacid: 300 mg–2 g daily to qid PO, usually 1–3 hr after meals and at bedtime.
Elderly patients: 1 or 2 tablets PO every 4 hr; maximum, 12 tablets/24 hr for maximum of 2 wk.
Younger than 60 yr: 1–4 tablets PO every 4 hr; maximum, 24 tablets/24 hr for maximum of 2 wk.
Adjunct to advanced CV life support during CPR: Although no longer routinely recommended, inject IV either 300–500 mL of a 5% solution or 200–300 mEq of a 7.5% or 8.4% solution as rapidly as possible. Base further doses on subsequent blood gas values. Alternatively for adults, 1 mEq/kg dose, IV, then repeat 0.5 mEq/kg every 10 min.
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