Sodium Bicarbonate

Mechanism of Action

Bicarbonate reacts with H+ ions to form water & carbon dioxide. It acts as a buffer against acidosis by raising blood pH

Pharmacokinetics

Onset: 15 min (IV)

Duration: 1-2 hr (IV); 8-10 min (PO)

Therapeutic range: 24-31 mEq/L

Excretion: Urine

Absorption: Well absorbed orally

IV Incompatibilities

Additive: ascorbic acid, carboplatin, carmustine, ciprofloxacin, cisplatin, dobutamine, dopamine, epinephrine, hydromorphone, imipenem-cilastatin, labetalol, meperidine (?), meropenem, morphine, norepinephrine, penicillin G potassium, pentazocine, pentobarbital, procaine, sodium lactate, streptomycin, succinylcholine, vancomycin(?), vit B/C

Syringe: bupivacaine(?), epinephrine(?), etidocaine, glycopyrrolate, lidocaine(?), mepivacaine, metoclopramide, thiopental

Y-site: allopurinol, amiodarone, ampho B cholesterylSO4, CaCl2, Ca gluconate, ciprofloxacin(?), cisatarcurium(?), doxorubicin liposomal, fenoldopam, hetastarch, idarubicin, imipenem-cilastatin, inamrinone, leucovorin, midazolam, nalbuphine, ondansetron, oxacillin, sargramostim, verapamil, vincristine, vindesine, vinorelbine

Not spec: diazepam, tetracycline

IV Compatibilities

Additive: aminophylline, ampho B, atropine, Ca gluconate, clindamycin, erythromycin, heparin, hydrocortisone, KCl, verapamil

Syringe: heparin

Y-site: heparin, morphine, KCl, vancomycin, vit B/C

IV Administration

Administered IV, either undiluted or diluted in other fluids, or

By SC if diluted to isotonicity

Storage

Store at controlled room temperature

Protect from freezing & temp >40°C

Do not use if unclear or contains a precipitate

Sodium bicarbonate is the generic name for a drug that is most commonly used to calm upset stomach caused by irritation from acid reflux.

It's available in tablet form and is also sold in combination with omeprazole (Prilosec) as the over-the-counter (OTC) drug Zegerid for acid reflux.

Sodium bicarbonate belongs to a class of drugs called antacids.

An injectable form of sodium bicarbonate is also given by healthcare practitioners to help improve the acid-base balance of the body when it becomes too acidic, which happens in severe cases of diabetes, shock, kidney failure, dehydration, and a condition known as lactic acidosis.

Sodium Bicarbonate Warnings

If you have any of the following conditions, tell your doctor, who may advise you not to take sodium bicarbonate or to watch for certain types of reactions.

• Allergies to sodium bicarbonate or any other ingredients of the medication
• Kidney problems
• Congestive heart failure

If you have abnormal levels of sodium, potassium, calcium, or chlorine, your doctor may advise you not to take sodium bicarbonate, or to least monitor levels of your electrolytes closely.

Before taking sodium bicarbonate, tell your doctor if you are on a low-sodium diet or if you have a rare kidney disorder known as Bartter syndrome, because it causes potassium, sodium, and chloride levels to be out of balance.

If your body's pH is higher than normal (known as alkalosis), you should not take sodium bicarbonate.

People taking sodium bicarbonate should try not to consume large amounts of high calcium-containing foods (such as milk, cheese, or yogurt) and should not take calcium supplements.

Pregnancy and Sodium Bicarbonate

Sodium bicarbonate falls under the FDA's Pregnancy Category C, which means that it should be avoided because we don't know if it will harm to an unborn baby or fetus.

You should tell your doctor if you are pregnant or plan to become pregnant before taking this medication.

You should also alert your physician if you are breastfeeding or plan to breastfeed.

Sodium Bicarbonate is used in the treatment of:

• Acidosis, Renal Tubular
• Dyspepsia
• Gastroesophageal Reflux
• Heart Arrest
• Heartburn
• Hyperkalemia
• Drug Overdose

Sodium Bicarbonate is used in the prevention of:

• Drug Toxicity

This medication may be prescribed for other uses. Ask your doctor or pharmacist for more information.

Sodium Bicarbonate may be found in some form under the following brand names:

• Alka-Seltzer

• Alka-Seltzer Gold

• Alka-Seltzer Heartburn Plus Gas Relief Relief

• Brioschi

• Bromo Seltzer Antacid Pain Reliever

• Ceo-Two

• Clenz-Lyte

• Colyte

• Desempacho

• Elliotts B

• Endosol Extra

• Gaviltye-G

• GaviLyte-C

• GaviLyte-N

• Gingera

• GoLYTELY

• Halflytely

• Navstel

• Neut

• NuLYTELY

• Picot

• Pleo Alkala

• TriLyte

• Zegerid

• Zegerid with Magnesium Hydroxide

Tell your doctor if you are pregnant or plan to become pregnant.

The FDA categorizes medications based on safety for use during pregnancy. Five categories - A, B, C, D, and X, are used to classify the possible risks to an unborn baby when a medication is taken during pregnancy.

Sodium Bicarbonate falls into category C:

In animal studies, pregnant animals were given this medication and had some babies born with problems. No well-controlled studies have been done in humans, though. Therefore, this medication may be used if the potential benefits to the mother outweigh the potential risks to the unborn child.

OR

There are no well-controlled studies that have been done in pregnant women. Sodium Bicarbonate should be used during pregnancy only if the possible benefit outweighs the possible risk to the unborn baby.

OR

No studies have been done in animals, and no well-controlled studies have been done in pregnant women. Sodium Bicarbonate should be given to a pregnant woman only if clearly needed.

Ask a doctor or pharmacist before taking this medicine if you are on a low-salt diet, or if you have high blood pressure.

Avoid taking this medicine without a doctor's advice if you regularly take other medicines.

Get emergency medical help if you have signs of an allergic reaction: hives; difficult breathing; swelling of your face, lips, tongue, or throat.

Stop using sodium bicarbonate and call your doctor at once if you have:

• severe stomach pain;

• swelling, rapid weight gain; or

• shortness of breath (even with mild exertion).

Common side effects may include:

• dry mouth;

• increased thirst; or

• urinating more than usual.

This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

The potentially large loads of sodium given with bicarbonate require that caution be exercised in the use of Sodium Bicarbonate in patients with congestive heart failure or other edematous or sodium-retaining states, as well as in patients with oliguria or anuria. See table in HOW SUPPLIED section for amounts of sodium present in solutions.

Caution must be exercised in the administration of parenteral fluids, especially those containing sodium ions, to patients receiving corticosteroids or corticotropin.

Potassium depletion may predispose to metabolic alkalosis and coexistent hypocalcemia may be associated with carpopedal spasm as the plasma pH rises. These dangers can be minimized if such electrolyte imbalances are appropriately treated prior to or concomitantly with bicarbonate infusion.

Pediatrics
Rapid injection (10 mL/min) of hypertonic Sodium Bicarbonate Injection, USP solutions into neonates and children under two years of age may produce hypernatremia, a decrease in cerebrospinal fluid pressure and possible intracranial hemorrhage. The rate of administration in such patients should therefore be limited to no more than 8 mEq/kg/day. A 4.2% solution may be preferred for such slow administration. In emergencies such as cardiac arrest, the risk of rapid infusion must be weighed against the potential for fatality due to acidosis.

Drug Interactions
Additives may be incompatible; norepinephrine and dobutamine are incompatible with Sodium Bicarbonate solution.

The addition of Sodium Bicarbonate to parenteral solutions containing calcium should be avoided, except where compatibility has been previously established. Precipitation or haze may result from Sodium Bicarbonate/calcium admixtures. NOTE: Do not use the injection if it contains precipitate.

Additives may be incompatible. Consult with pharmacist, if available. When introducing additives, use aseptic technique, mix thoroughly and do not store.

Laboratory Tests
The aim of all bicarbonate therapy is to produce a substantial correction of the low total CO2 content and blood pH, but the risks of overdosage and alkalosis should be avoided. Hence, repeated fractional doses and periodic monitoring by appropriate laboratory tests are recommended to minimize the possibility of overdosage.

Pregnancy:
Teratogenic Effects. Pregnancy Category C. Animal reproduction studies have not been conducted with Sodium Bicarbonate. It is also not known whether Sodium Bicarbonate can cause fetal harm when administered to a pregnant woman or can affect reproduction capacity. Sodium Bicarbonate should be given to a pregnant woman only if clearly needed.

Oral: 15 minutes; IV: Rapid

Contrast-induced nephropathy (CIN) (prevention)

Evidence from controlled trials supports the use of isotonic sodium bicarbonate as an effective option in the prevention of contrast-induced nephropathy (CIN), demonstrating reduced incidence compared to sodium chloride (Merten 2004, Ozcan 2007). Meta-analyses have found effectiveness of sodium bicarbonate to be uncertain and noted that study heterogeneity and publication bias are substantial (Brar 2009, Zoungas 2009).

Kidney Disease Improving Global Outcomes (KDIGO) guidelines state that in patients at increased risk of contrast-induced acute kidney injury (CI-AKI), IV volume expansion with either isotonic sodium chloride or isotonic sodium bicarbonate solutions is recommended rather than no IV volume expansion. Isotonic sodium bicarbonate is not commercially available, and thus carries a risk for compounding error during preparation. Based on the potential for harm and additional burden of preparing bicarbonate solutions, no preference is given to one solution; either agent can be used, with ease of use recognized for isotonic saline (KDIGO 2012a). European Society of Urogenital Radiology (ESUR) Contrast Media Safety Committee guidelines state that IV isotonic sodium bicarbonate appears to provide protection equal or superior to IV isotonic saline, but either regimen may be used (ESUR [Stacul 2011]).

Prevention of contrast-induced nephropathy (off-label use): Remove 154 mL from 1000 mL bag of D5W; replace with 154 mL of 8.4% sodium bicarbonate; resultant concentration is 154 mEq/L (Merten 2004); more practically, institutions may remove 150 mL from 1000 mL bag of D5W and replace with 150 mL of 8.4% sodium bicarbonate; resultant concentration is 150 mEq/L

Neutralizing additive (dental use): Add specified volume of 8.4% sodium bicarbonate directly with lidocaine and epinephrine injection and mix; use immediately after mixing.