SODIUM BICARBONATE

Clinical safety rating: safe

Animal studies have demonstrated safety

How it works

Sodium bicarbonate dissociates to provide bicarbonate ion, which buffers excess hydrogen ions in the blood, increasing pH and reversing acidosis.

What the body does with it

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

Classification & Brands

Dosing & administration

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.

Use during pregnancy

1st trimester	Consult provider
2nd trimester	Consult provider
3rd trimester	Consult provider

Clinical note

Can decrease the levels of many drugs by increasing urinary pH Can cause metabolic alkalosis and fluid overload.

Breastfeeding	Sodium bicarbonate is excreted into breast milk in small amounts. M/P ratio is not established. Considered compatible with breastfeeding, but monitor infant for metabolic alkalosis risk.
Teratogenic Risk	Sodium bicarbonate is generally considered low risk. No evidence of teratogenicity. Use during pregnancy is acceptable if clinically indicated.
Fetal Monitoring

Warnings & precautions

■ FDA Black Box Warning

In cardiac arrest, routine use is not recommended; may cause paradoxical intracellular acidosis, hyperosmolality, and decreased tissue oxygen delivery.

Side Effect Profile

Common Effects	hyperkalemia
Serious Effects

Absolute Contraindications

["Metabolic alkalosis","Respiratory alkalosis","Hypocalcemia (unless used to treat cardiac arrest)","Severe pulmonary edema or hypertension","Patients losing chloride from vomiting or gastrointestinal suction"]

Clinical Precautions

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"]

Clinical Tips & Counseling

Drug interactions

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