SODIUM BICARBONATE NA(HCO3)

Generic Name SODIUM

BICARBONATE
NA(HCO3)
Brand Name Sodium Bicarbonate

Classification GASTROINTESTINAL AGENT; ANTACID; FLUID AND

ELECTROLYTE BALANCE AGENT
General Action Short-acting, potent systemic antacid. Rapidly neutralizes gastric acid to
form sodium chloride, carbon dioxide, and water. After absorption of
sodium bicarbonate, plasma alkali reserve is increased and excess sodium
and bicarbonate ions are excreted in urine, thus rendering urine less acid.
Not suitable for treatment of peptic ulcer because it is short-acting, high in
sodium, and may cause gastric distention, systemic alkalosis, and possibly
acid-rebound.
Dose and Route Antacid
Adult: PO 0.3–2 g 1–4 times/d or ½ tsp of powder in glass of water

Urinary Alkalinizer
Adult: PO 4 g initially, then 1–2 g q4h
Child: PO 84–840 mg/kg/d in divided doses

Cardiac Arrest
Adult: IV 1 mEq/kg of a 7.5% or 8.4% solution initially, then 0.5 mEq/kg
q10 min depending on arterial blood gas determinations (8.4% solutions
 contain 50 mEq/50 mL), give over 1–2 min
Child: IV 0.5–1 mEq/kg of a 4.2% solution q10 min depending on arterial
blood gas determinations, give over 1–2 min

Metabolic Acidosis
Adult: IV 2–5 mEq/kg by IV infusion over 4–8 h
Infant: IV 2–3 mEq/kg/d of a 4.2% solution over 4–8 h
Indications or Systemic alkalinizer to correct metabolic acidosis (as occurs in diabetes
Purposes mellitus, shock, cardiac arrest, or vascular collapse), to minimize uric acid
crystallization associated with uricosuric agents, to increase the solubility
of sulfonamides, and to enhance renal excretion of barbiturate and
salicylate overdosage. Commonly used as home remedy for relief of
occasional heartburn, indigestion, or sour stomach. Used topically as paste,
bath, or soak to relieve itching and minor skin irritations such as sunburn,
insect bites, prickly heat, poison ivy, sumac, or oak. Sterile solutions are
used to buffer acidic parenteral solutions to prevent acidosis. Also as a
buffering agent in many commercial products (e.g., mouthwashes, douches,
enemas, ophthalmic solutions).
Side effects GI: Belching, gastric distention, flatulence.
Metabolic: Metabolic alkalosis; electrolyte imbalance: sodium overload
(pulmonary edema), hypocalcemia (tetany), hypokalemia, milk-alkali
syndrome, dehydration.
Other: Rapid IV in neonates (Hypernatremia, reduction in CSF
pressure, intracranial hemorrhage).
Skin: Severe tissue damage following extravasation of IV solution.
Urogenital: Renal calculi or crystals, impaired kidney function.
Contraindications Prolonged therapy with sodium bicarbonate; patients losing chloride (as
from vomiting, GI suction, diuresis); heart disease, hypertension; renal
insufficiency; peptic ulcer; pregnancy (category C).
Nursing Assessment & Drug Effects
Responsibilities
 Be aware that long-term use of oral preparation with milk or
calcium can cause milk-alkali syndrome: Anorexia, nausea,
vomiting, headache, mental confusion, hypercalcemia,
hypophosphatemia, soft tissue calcification, renal and ureteral
calculi, renal insufficiency, metabolic alkalosis.
 Lab tests: Urinary alkalinization: Monitor urinary pH as a guide to
dosage (pH testing with nitrazine paper may be done at intervals
throughout the day and dosage adjustments made accordingly).
 Lab tests: Metabolic acidosis: Monitor patient closely by
observations of clinical condition; measurements of acid-base status
(blood pH, Po2, Pco2, HCO3 –, and other electrolytes, are usually
made several times daily during acute period). Observe for signs of
 alkalosis (over treatment) (see Appendix F).
 Observe for and report S&S of improvement or reversal of
metabolic acidosis (see Appendix F).

Patient & Family Education

 Do not use sodium bicarbonate as antacid. A nonabsorbable OTC

alternative for repeated use is safer.
 Do not take antacids longer than 2 wk except under advice and
supervision of a physician. Self-medication with routine doses of
sodium bicarbonate or soda mints may cause sodium retention and
alkalosis, especially when kidney function is impaired.
 Be aware that commonly used OTC antacid products contain
sodium bicarbonate: Alka-Seltzer, Bromo-Seltzer, Gaviscon.
 Do not breast feed while taking this drug without consulting
physician.