SODIUM BICARBONATE NA(HCO3)
| SODIUM BICARBONATE NA(HCO3)
Classifications: fluid and electrolyte balance agent; antacid; Therapeutic: antacid
Pregnancy Category: C
325 mg, 520 mg, 650 mg tablets; 4.2%, 5%, 7.5%, 8.4% injection
Short-acting, potent systemic antacid and alkalinizing agent. 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.
Short-acting, potent systemic antacid; rapidly neutralizes gastric acid or systemic acidosis.
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).
Prolonged therapy with sodium bicarbonate; patients losing chloride (as from vomiting, GI suction, diuresis); hypocalcemia; metabolic alkalosis; respiratory alkalosis; peptic ulcer; pregnancy (category C).
Route & Dosage
Adult: PO 0.32 g 14 times/d or ? tsp of powder in glass of water
Adult: PO 4 g initially, then 12 g q4h
Child: PO 84840 mg/kg/d in divided doses
Adult: IV 1 mEq/kg initially, then 0.5 mEq/kg q10 min depending on arterial blood gas determinations (8.4% solutions contain 50 mEq/50 mL), give over 12 min
Child: IV 0.51 mEq/kg q10 min depending on arterial blood gas determinations, give over 12 min
Adult/Child: IV Dose adjusted according to pH, base deficit, PaCO 2, fluid limits, and patient response.
- Do not add oral preparation to calcium-containing solutions.
- Use manufacturer's directions: Bath or soak, ? cup or more into tub of warm water; footsoak, 4 tbsp/L(qt) warm water; soak 510 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.
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 25 mEq/kg over 48 h; do not exceed 50 mEq/h. Flush line before/after with NS.??Stop infusion immediately if extravasation occurs. Severe tissue damage has followed tissue infiltration.
INCOMPATIBILITIES Solution/additive: Alcohol 5%, lactated Ringer's, amoxicillin, ascorbic acid, bupivacaine, carboplatin, carmustine, ciprofloxacin, cisplatin, codeine, corticotropin, dobutamine, dopamine, epinephrine, glycopyrrolate, hydromorphone, imipenem-cilastatin, insulin, isoproterenol, labetalol, levorphanol, magnesium sulfate, meperidine, meropenem, methadone, metoclopramide, morphine, norepinephrine, oxytetracycline, penicillin G, pentazocine, pentobarbital, phenobarbital, procaine, promazine, streptomycin, succinylcholine, tetracycline, thiopental, vancomycin, vitamin B complex with C. Y-site: Allopurinol, amiodarone, amphotericin B cholesteryl complex, calcium chloride, ciprofloxacin, cisatracurium, diltiazem, doxorubicin liposome, fenoldopam, hetastarch, idarubicin, imipenem/cilastatin, inamrinone, leucovorin, lidocaine, midazolam, nalbuphine, ondansetron, oxacillin, sargramostim, verapamil, vincristine, vindesine, vinorelbine.
- Store in airtight containers.
- Note expiration date.
Adverse Effects (≥1%)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.
Diagnostic Test Interference
Small increase in blood lactate levels (following IV infusion of sodium bicarbonate); false-positive urinary protein determinations (using ames reagent, sulfacetic acid, heat and acetic acid or nitric acid ring method); elevated urinary urobilinogen levels (urobilinogen excretion increases in alkaline urine).
InteractionsDrug: May decrease absorption of ketoconazole; may decrease elimination of dextroamphetamine, ephedrine, pseudoephedrine, quinidine; may increase elimination of chlorpropamide, lithium, salicylates, tetracyclines.
PharmacokineticsAbsorption: Readily from GI tract. Onset: 15 min. Duration: 12 h. Elimination: In urine within 34 h.
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) (see Appendix F).
- Observe for and report S&S of improvement or reversal of metabolic acidosis (see Appendix F).
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.