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Chemistry – An alkalinizing agent, sodium bicarbonate occurs as a white, crystalline powder having a slightly saline or alkaline taste. It is soluble in water and insoluble in alcohol. One gram of sodium bicarbonate contains about 12 mEq each of sodium and bicarbonate; 84 mg of sodium bicarbonate contains 1 mEq each of sodium and bicarbonate. A 1.5% solution of sodium bicarbonate is approximately isotonic. An 8.4% solution of sodium bicarbonate can be made isotonic by diluting each ml with 4.6 ml of sterile water for injection.
Sodium bicarbonate may also be known as: Baking Soda , Sodium Hydrogen Carbonate , Sodium Acid Carbonate , or by its chemical abbreviation, NaHCO3 .
Storage/Stability/Compatibility – Sodium bicarbonate tablets should be stored in tight containers, preferably at room temperature (15-30°C). Sodium bicarbonate injection should be stored at temperatures less than 40°C and preferably at room temperature; avoid freezing.
Sodium bicarbonate powder is stable in dry air, but will slowly decompose upon exposure to moist air.
Sodium bicarbonate is reportedly compatible with the following intravenous solutions and drugs: Dextrose in water, dextrose/saline combinations, dextrose-Ringer’s combinations, sodium chloride injections, amikacin sulfate, aminophylline, amobarbital sodium, amphotericin B, atropine sulfate, bretylium tosylate, carbenicillin disodium, cefoxitin sodium, cephalothin sodium, cephapirin sodium, chloramphenicol sodium succinate, chlorothiazide sodium, cimetidine HCl, clindamycin phosphate, ergonavine maleate, erythromycin gluceptate/lactobionate, Innovar®, heparin sodium, hyaluronidase, hydrocortisone sodium succinate, kanamycin sulfate, lidocaine HCl, metaraminol bitartrate, methotrexate sodium, methyldopate HCl, nafcillin sodium, netilmicin sulfate, oxacillin sodium, oxytocin, phenobarbital sodium, phenylephrine HCl, phenytoin sodium, phytonadione, potassium chloride, prochlorperazine edisylate, and sodium iodide.
Sodium bicarbonate compatibility information conflicts or is dependent on diluent or concentration factors with the following drugs or solutions: lactated Ringer’s injection, Ringer’s injection, sodium lactate 1/6 M, ampicillin sodium, calcium chloride/gluconate, methicillin sodium, penicillin G potassium, pentobarbital sodium, promazine HCl, thiopental sodium, vancomycin HCl, verapamil HCl, and vitamin B-complex w/C. Compatibility is dependent upon factors such as pH, concentration, temperature and diluents used. It is suggested to consult specialized references for more specific information (e.g., Handbook on Injectable Drugs by Trissel; see bibliography).
Sodium bicarbonate is reportedly incompatible with the following solutions or drugs: alcohol 5%/dextrose 5%, D5 lactated Ringer’s, amrinone lactate, ascorbic acid injection, carmustine, cisplatin, codeine phosphate, corticotropin, dobutamine HCl, epinephrine HCl, glycopyrrolate, hydromorphone HCl, imipenem-cilastatin, regular insulin, isoproterenol HCl, labetolol HCl, levorphanol bitartrate, magnesium sulfate, meperidine HCl, methadone HCl, metoclopramide HCl, norepinephrine bitartrate, oxytetracycline HCl, pentazocine lactate, procaine HCl, secobarbital sodium, streptomycin sulfate, succinylcholine chloride, tetracycline HCl,
Pharmacology – Bicarbonate ion is the conjugate base component of bicarbonate:carbonic acid buffer, the principal extracellular buffer in the body.
Uses/Indications – Sodium bicarbonate is indicated to treat metabolic acidosis and to alkalinize the urine. It is also used as adjunctive therapy in treating hypercalcemic or hyperkalemia crises.
Contraindications/Precautions/Reproductive Safety – Parenterally administered sodium bicarbonate is considered generally contraindicated in patients with metabolic or respiratory alkalosis, excessive chloride loss secondary to vomiting or GI suction, at risk for development of diuretic-induced hypochloremic alkolosis, or with hypocalcemia where alkalosis may induce tetany.
Use with extreme caution and give very slowly in patients with hypocalcemia. Because of the potential sodium load, use with caution in patients with CHF, nephrotic syndrome, hypertension, oliguria, or volume overload. Reproductive safety studies have not been performed. Assess risk versus benefit before using.
Adverse Effects/Warnings – Sodium bicarbonate therapy (particularly high-dose parenteral use) can lead to metabolic alkalosis, hypokalemia, hypocalcemia, “overshoot” alkalosis, hypernatremia, volume overload, congestive heart failure, shifts in the oxygen dissociation curve causing decreased tissue oxygenation, and paradoxical CNS acidosis leading to respiratory arrest.
When sodium bicarbonate is used during cardiopulmonary resuscitation, hypercapnia may result if the patient is not well ventilated; patients may be predisposed to ventricular fibrillation.
Oral & parenteral bicarbonate (especially at higher doses) may contribute significant amounts of sodium and result in hypernatremia and volume overload; use with caution in patients with CHF, or acute renal failure.
Overdosage/Acute Toxicity – Sodium bicarbonate can cause severe alkalosis, with irritability or tetany if overdosed or given too rapidly. Dosages should be thoroughly checked and frequent monitoring of electrolyte and acid/base status performed.
Treatment may consist of simply discontinuing bicarbonate if alkalosis is mild, or by using a rebreathing mask. Severe alkalosis may require intravenous calcium therapy. Sodium chloride or potassium chloride may be necessary if hypokalemia is present.
Drug Interactions – Because oral sodium bicarbonate can either increase or reduce the rate and/or extent of absorption of many orally administered drugs, it is recommended to avoid giving other drugs within 1-2 hours of sodium bicarbonate. Oral sodium bicarbonate may increase the amount of naproxen absorbed. Oral sodium bicarbonate may reduce the amount and/or extent absorbed of the following drugs: anticholinergic agents, Histamine2 blocking agents (e.g., cimetidine, ranitidine), iron products, ketoconazole, and tetracyclines. Sodium bicarbonate may reduce the efficacy of sucralfate if administered concurrently.
When urine is alkalinized by sodium bicarbonate, excretion of certain drugs (e.g., quinidine, amphetamines, ephedrine) is decreased, and excretion of weakly acidic drugs (e.g., salicylates) is increased. The solubility of ciprofloxacin & enrofloxacin is decreased in an alkaline environment. Patients with alkaline urine should be monitored for signs of crystalluria.
Concurrent use of sodium bicarbonate in patients receiving potassium-wasting diuretics (e.g., thiazides, furosemide) may cause hypochloremic alkalosis. Patients receiving high dosages of sodium bicarbonate and ACTH or glucocorticoids may develop hypernatremia.
For metabolic acidosis:
a) Associated with colic; if pH is <7.3 and base deficit is >10 mEq/L estimate bicarbonate requirement using the formula: bicarbonate deficit (HCO-3 mEq) = base deficit (mEq/L) x 0.4 x body weight (kg). May administer as a 5% sodium bicarbonate solution. Each L of solution contains 600 mEq of bicarbonate (hypertonic) and should not be administered any faster than 1 – 2 L/hr. Because acidotic horses with colic tend also to be dehydrated, may be preferable to give as isotonic sodium bicarbonate (150 mEq/L). (Stover 1987)
Monitoring Parameters –
1) Acid/base status
2) Serum electrolytes
3) Urine pH (if being used to alkalinize urine)
Dosage Forms/Preparations/FDA Approval Status/Withholding Times –
Sodium bicarbonate 5% (0.6 mEq/ml) in 500 ml vials (297.5 mEq/500 ml)
Sodium bicarbonate 8.4% (1 mEq/ml) in 50 ml (50 mEq/vial), 100 ml (100 mEq/vial) and 500 ml (500 mEq/vial) vials
Available generically labeled; (Rx). Approval status unknown.
Sodium bicarbonate 4% (0.48 mEq/ml) in 5 & 10 ml vials
Sodium bicarbonate 4.2% (0.5 mEq/ml) in 5 & 10 ml syringes
Sodium bicarbonate 5% (0.6 mEq/ml) in 500 ml vials (297.5 mEq/500 ml)
Sodium bicarbonate 7.5% (0.9 mEq/ml) in 50 ml amps, syringes and vials (44.6 mEq/50 ml)
Sodium bicarbonate 8.4% (1 mEq/ml) in 10 ml syringes (10 mEq) & 50 ml vials (50 mEq/vial)
Available generically labeled; (Rx).
Oral Tablets 325 mg (5 grain), 650 mg (10 grain)
May be labeled generically or as Soda Mint ; (OTC)