IDENTIFICATION AND USE: Sodium bicarbonate reduces stomach acid. It is used as an antacid to treat heartburn, indigestion, and upset stomach. Sodium bicarbonate is a very quick-acting antacid. It should be used only for temporary relief. It works by neutralizing excess acid in the blood. It may also replace bicarbonate when there are excess losses from the body. Sodium bicarbonate is the active ingredient in baking soda.

This medication may be used to make the urine less acidic. This effect helps the kidneys get rid of uric acid, thereby helping to prevent gout and kidney stones. It can make some medications (e.g., sulfonamides) work better or can help your body get rid of too much medication (e.g., phenobarbital). This medication can also prevent and treat certain metabolic problems (acidosis) caused by kidney disease.

HUMAN EXPOSURE/TOXICITY: 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.

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.

Experimentally, the administration of intravenous hypertonic sodium bicarbonate has been associated with increased serum osmolality, decreased ionized serum calcium (which is associated with decreased myocardial contractility), and peripheral vasodilation.

Some experts recommend invasive hemodynamic monitoring in acidotic patients before the administration of bicarbonate.

ADVERSE EFFECTS: frequent urge to urinate, headache (continuing), loss of appetite (continuing), mood or mental changes, muscle pain or twitching, nausea or vomiting, nervousness or restlessness, slow breathing, swelling of feet or lower legs, unpleasant taste, unusual tiredness or weakness.

GASTROINTESTINAL SIDE EFFECTS: gastric rupture. As an antacid, sodium bicarbonate, especially after excess food or liquid, can cause excess gas release (when combined with gastric acid). The mortality associated with gastric rupture is as high as 65%. Urinary alkalinization from bicarbonate can cause a falsely positive colorimetric assay for protein.

RENAL SIDE EFFECTS: “False” proteinuria – an excess of serum proteins in the urine, such as in renal disease, after strenuous exercise, or in dehydration.

RESPIRATORY SIDE EFFECTS: suppressed respiratory drive. Rapid infusion of hyperosmolar sodium bicarbonate has been associated with intraventricular hemorrhage in the pediatric literature. Irritability and tetany have been associated with sodium bicarbonate-induced alkalosis or hypernatremia. Due to greater permeability of the blood-brain barrier to hydrogen than to bicarbonate, the pH of cerebrospinal fluid may significantly decrease during sodium bicarbonate administration, which can cause mental stupor or coma.

NERVOUS SYSTEM SIDE EFFECTS: irritability, tetany, mental stupor, coma, and intraventricular hemorrhage.

LOCAL SIDE EFFECTS: IV site pain, venous irritation, and extravasation. Cellulitis, tissue necrosis, ulceration, or skin sloughing have possibly been the result of extravasation. A slow rate of administration of a properly diluted solution into a large bore needle and vein is recommended if IV administration is necessary.

CARDIOVASCULAR SIDE EFFECTS: decreased cardiac contractility possibly resulting from infusion of sodium bicarbonate in patients with severe acidosis.