Brand Name
Arm and Hammer Pure Baking Soda, Bell/ans, Citrocarbonate, Soda
Mint
Class and Category
Chemical class: Electrolyte
Therapeutic class: Antacid, electrolyte replenisher,
systemic and urinary alkalizer
Pregnancy category: C
Indications and Dosages
To treat hyperacidity
EFFERVESCENT POWDER
Adults and adolescents. 3.9 to 10 g in a glass of water
after meals. Maximum: 19.5 g daily. Children ages 6 to 12. 1 to 1.9 g in
a glass of water after meals.
ORAL POWDER
Adults and adolescents. One-half tsp in a glass of water
every 2 hr, p.r.n. Maximum: 4 tsp daily in patients up to age 60.
TABLETS
Adults and adolescents. 325 mg to 2 g daily to q.i.d.,
p.r.n. Maximum: 16 g daily.
Children ages 6 to 12. 520 mg, repeated once after 30
min, p.r.n.
To provide urinary
alkalization
ORAL POWDER
Adults and adolescents. 1 tsp in a glass of water every 4
hr. Maximum: 4 tsp daily in patients up to age 60.
TABLETS
Adults and adolescents. Initial: 4 g, then 1
to 2 g every 4 hr. Maximum: 16 g daily.
Children. 23 to 230 mg/kg daily, adjusted p.r.n.
I.V. INFUSION
Adults and children. 2 to 5 mEq/kg over 4 to 8 hr.
To treat metabolic acidosis during cardiac arrest
I.V. INJECTION
Adults and children. Initial: 1 mEq/kg,
followed by 0.5 mEq/kg every 10 min while arrest continues.
To treat less urgent forms of metabolic acidosis
I.V. INFUSION
Adults and children. 2 to 5 mEq/kg over 4 to 8 hr.
DOSAGE ADJUSTMENT Dosage reduction possible for
elderly patients because of agerelated renal impairment.
Mechanism of Action
Increases
plasma bicarbonate level, buffers excess hydrogen ions, and raises blood pH, thereby
reversing metabolic acidosis. Sodium bicarbonate also increases the excretion
of free bicarbonate ions in urine, raising urine pH; increased alkalinity of urine
may help to dissolve uric acid calculi. In addition, it relieves symptoms of hyperacidity by
neutralizing or buffering existing stomach acid, thereby increasing the pH of stomach
contents.
Incompatibilities
Don’t admix I.V. form of sodium bicarbonate in same solution or
administer through same I.V. line as other drugs because precipitate may form.
Contraindications
Hypocalcemia in which alkalosis may lead to tetany; hypochloremic
alkalosis secondary to vomiting, diuretics, or nasogastric suction; preexisting
metabolic or respiratory alkalosis
Interactions
DRUGS
amphetamines, quinidine: Decreased urinary excretion of
these drugs, possibly resulting in toxicity
anticholinergics: Decreased anticholinergic absorption
and effectiveness
calcium-containing products: Increased risk of milk-alkali
syndrome
chlorpropamide, lithium, salicylates, tetracyclines:\ Increased
renal excretion and decreased absorption of these drugs
ciprofloxacin, norfloxacin, ofloxacin: Decreased
solubility of these drugs, leading to crystalluria and nephrotoxicity
citrates: Increased risk of systemic alkalosis; increased
risk of calcium calculus formation and hypernatremia in patients with history
of uric acid calculi
digoxin: Possibly elevated digoxin level
enteric-coated drugs: Increased risk of gastric or duodenal
irritation from rapid removal of enteric coating
ephedrine: Increased ephedrine half-life and duration of
action
H2-receptor antagonists, iron supplements or preparations,
ketoconazole: Decreased absorption of these drugs
mecamylamine: Decreased excretion and prolonged effect of
mecamylamine
methenamine: Decreased methenamine effectiveness
mexiletine: Possibly mexiletine toxicity
potassium supplements: Decreased serum potassium level
sucralfate: Interference with binding of sucralfate to
gastric mucosa
urinary acidifiers (ammonium chloride, ascorbic acid, potassium
and sodium phosphates): Counteracted effects of urinary acidifiers
FOODS
dairy products: Increased risk of milk-alkali syndrome
with prolonged use of sodium bicarbonate
Adverse Reactions
CNS: Mental or mood changes
CV: Irregular heartbeat, peripheral edema (with large doses), weak
pulse
EENT: Dry mouth
GI: Abdominal cramps, thirst
MS: Muscle spasms, myalgia
SKIN: Extravasation with necrosis, tissue sloughing, or ulceration
Nursing Considerations
•Monitor sodium intake of patient taking sodium bicarbonate
because effervescent powder contains 700.6 mg of sodium/ 3.9 g; oral powder
contains 952 mg of sodium/tsp; and tablets contain 325 mg/ 3.9-mEq tablet, 520
mg/6.2-mEq tablet, and 650 mg/7.7-mEq tablet.
•
For I.V. infusion, dilute drug with normal saline solution, D5W, or other
standard electrolyte solution before administration.
•
Avoid rapid I.V. infusion, which can cause severe alkalosis. Be aware that
during cardiac arrest, risk of death from acidosis may outweigh risks of rapid
infusion.
•Monitor
urine pH, as ordered, to determine drug’s effectiveness as urine alkalizer.
•
If patient on long-term sodium bicarbonate therapy is consuming calcium or
milk, watch for milk-alkali syndrome, characterized by anorexia, confusion,
headache, hypercalcemia, metabolic acidosis, nausea, renal insufficiency, and
vomiting.
•
Be aware that parenteral forms are hypertonic and that increased sodium intake can
produce edema and weight gain.
•
Assess I.V. site often for evidence of extravasation. If it occurs, notify
prescriber at once and remove I.V. catheter. Elevate the limb, apply warm
compresses, and expect prescriber to administer a local injection of
hyaluronidase or lidocaine.
PATIENT
TEACHING
•
Advise patient not to take sodium bicarbonate with large amounts of dairy products
or for longer than 2 weeks, unless directed by prescriber.
•
Caution patient not to take more drug than prescribed to avoid adverse
reactions.
•
Direct patient not to take drug within 2 hours of other oral drugs.
•
Advise patient to avoid taking other prescribed or OTC drugs without
prescriber’s approval because many drugs interact with sodium bicarbonate. 