SODIUM BICARBONATE
Clinical safety rating
safeAnimal studies have demonstrated safety
Sodium bicarbonate dissociates to provide bicarbonate ion, which buffers excess hydrogen ions in the blood, increasing pH and reversing acidosis.
| Metabolism | Sodium bicarbonate is not metabolized; it dissociates to bicarbonate and sodium. Bicarbonate is rapidly converted to carbon dioxide by carbonic anhydrase in erythrocytes and renal tubules, and CO2 is excreted via lungs. |
| Excretion | Renal: >99% as bicarbonate; minimal biliary/fecal elimination |
| Half-life | 5-6 hours in normal renal function; prolonged in renal impairment (up to 15-20 hours) |
| Protein binding | <1% (not significantly protein bound) |
| Volume of Distribution | 0.3-0.4 L/kg (distributes primarily in extracellular fluid) |
| Bioavailability | Oral: ~100% (but rapid conversion to CO2 in stomach may reduce effective systemic absorption) |
| Onset of Action | Intravenous: immediate (within 1-2 minutes); Oral: 15-30 minutes |
| Duration of Action | Intravenous: 1-2 hours (buffer effect); Oral: 30-60 minutes (systemic effect); depends on acid-base status and renal function |
| Molecular Weight | 84.007 Da |
For metabolic acidosis: 50-150 mEq intravenously over 4-8 hours, dose adjusted based on base deficit or serum bicarbonate. For cardiac arrest: 1 mEq/kg intravenously initially, then 0.5 mEq/kg every 10 minutes. For urinary alkalinization: 325-2000 mg orally every 6 hours, titrate to urine pH 7-8.
| Dosage form | SOLUTION |
| Renal impairment | No specific dose adjustment required; monitor sodium and fluid status. In severe renal impairment (GFR <10 mL/min), use with caution due to risk of volume overload and metabolic alkalosis. Not removed by hemodialysis. |
| Liver impairment | No dosage adjustment necessary for hepatic impairment. Use with caution in severe hepatic impairment due to potential for fluid overload and electrolyte disturbances. |
| Pediatric use | Metabolic acidosis: 1-2 mEq/kg intravenously over 1-2 hours, repeat based on blood gas. Cardiac arrest: 1 mEq/kg intravenously initially, may repeat 0.5 mEq/kg every 10 minutes. Urinary alkalinization: 1-2 mEq/kg orally every 6 hours, adjust to urine pH. |
| Geriatric use | Use with caution due to increased risk of fluid overload and electrolyte imbalances. Start at lower end of dosing range and titrate based on response and renal function. Monitor serum sodium, bicarbonate, and renal function frequently. |
| 1st trimester | Sodium bicarbonate is generally considered safe in pregnancy when used at therapeutic doses. No known teratogenicity has been reported in animal studies. However, avoid prolonged use or high doses due to risk of metabolic alkalosis and electrolyte disturbances. |
| 2nd trimester | Same as T1. Monitor serum electrolytes and acid-base status if used systemically. |
| 3rd trimester | Use with caution near term due to risk of neonatal metabolic alkalosis or fluid overload, especially if high doses are used intravenously. |
Clinical note
Can decrease the levels of many drugs by increasing urinary pH Can cause metabolic alkalosis and fluid overload.
| Placental transfer | Sodium bicarbonate crosses the placenta freely as bicarbonate ions. Studies indicate rapid equilibrium between maternal and fetal compartments. Used therapeutically to correct fetal acidosis during labor. |
| Breastfeeding | Sodium bicarbonate is excreted into breast milk in low amounts. It is generally considered compatible with breastfeeding. However, high maternal doses may cause neonatal metabolic alkalosis or electrolyte imbalance. Monitor infant for signs of alkalosis (e.g., irritability, vomiting) if mother receives systemic doses. |
| Lactation Rating | L1 (Safe) or 'Compatible' |
| Teratogenic Risk | Sodium bicarbonate is generally considered low risk. No evidence of teratogenicity. Use during pregnancy is acceptable if clinically indicated. |
| Fetal Monitoring | Monitor serum electrolytes, bicarbonate, and acid-base status. Watch for fluid overload, hypernatremia, and hypocalcemia in mother; assess fetal heart rate during administration. |
| Fertility Effects | No known adverse effects on fertility. Does not significantly impact reproductive function. |
■ FDA Black Box Warning
In cardiac arrest, routine use is not recommended; may cause paradoxical intracellular acidosis, hyperosmolality, and decreased tissue oxygen delivery.
| Common Effects | hyperkalemia |
| Serious Effects |
Metabolic alkalosisHypocalcemia (risk of tetany due to decreased ionized calcium)Severe pulmonary edema or CHF (risk of fluid overload)Edematous states (e.g., cirrhosis, renal failure)Known hypersensitivity to sodium bicarbonate
| Precautions | Risk of metabolic alkalosis with excessive use, Fluid overload due to sodium content, especially in heart failure, renal impairment, or cirrhosis, Hypocalcemia and reduced ionized calcium leading to tetany, Extravasation risk; intravenous administration should be via central line for concentrated solutions, Monitor serum electrolytes, pH, and calcium during therapy |
| Food/Dietary | High-sodium foods may compound sodium load. Avoid excessive milk or dairy intake (risk of milk-alkali syndrome). Can interfere with iron absorption; take iron supplements 2 hours apart. No specific food restrictions beyond balanced diet. |
| Clinical Pearls | Contains 119 mEq sodium per 3.8 g (50 mEq base). Use with caution in heart failure, hypertension, or renal impairment. Rapid infusion can cause hypernatremia, decreased ionized calcium, and tetany. Do not mix with calcium-containing solutions or in the same IV line as catecholamines. In metabolic acidosis, correct only partially (to pH 7.2) to avoid rebound alkalosis. Not first-line for cardiac arrest except in known hyperkalemia or overdose. |
| Patient Advice | Do not take with milk or dairy products as it may cause milk-alkali syndrome. · Avoid taking within 2 hours of other medications as it may affect absorption. · Do not use as an antacid for more than 2 weeks unless directed by a doctor. · Seek emergency care if you have severe stomach pain, vomiting, or blood in vomit/stool. · Monitor for signs of alkalosis: muscle twitching, hand tremor, confusion, slow breathing. · Inform your doctor if you have high blood pressure, heart failure, or kidney disease. |
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