Return To The Previous Page
Buy a Package
Number Of Visible Items Remaining : 3 Item

Sodium bicarbonate: Drug information

Sodium bicarbonate: Drug information
(For additional information see "Sodium bicarbonate: Patient drug information" and see "Sodium bicarbonate: Pediatric drug information")

For abbreviations, symbols, and age group definitions used in Lexicomp (show table)
Pharmacologic Category
  • Alkalinizing Agent;
  • Antacid;
  • Electrolyte Supplement, Oral;
  • Electrolyte Supplement, Parenteral
Dosing: Adult

Note: Each 650 mg oral tablet contains ~7.7 mEq of sodium and 7.7 mEq of bicarbonate; each ½ teaspoon of powder contains sodium bicarbonate 2,616 mg, which is equal to 31.1 mEq of sodium bicarbonate. Each mL of 8.4% IV product provides 1 mEq/mL of sodium and 1 mEq/mL of bicarbonate. Avoid extravasation; tissue necrosis may occur due to hypertonicity and alkalinity (Ref).

Antacid

Antacid: Oral: 650 mg to 2.6 g every 4 hours as needed; maximum daily dose: 15.6 g/day. Do not use maximum dosage for >2 weeks.

Cardiac arrest, prolonged

Cardiac arrest, prolonged : IV: 1 mEq/kg/dose once; repeat doses should be guided by arterial blood gases (Ref).

Routine use of sodium bicarbonate is not recommended. May be considered in the setting of prolonged cardiac arrest only after adequate alveolar ventilation has been established and effective cardiac compressions. Note: In some cardiac arrest situations (eg, metabolic acidosis, hyperkalemia, or sodium channel blocker [eg, tricyclic antidepressant] overdose), sodium bicarbonate may be beneficial.

Cardiac conduction delays due to sodium channel blockade in overdose

Cardiac conduction delays due to sodium channel blockade in overdose (off-label use): Note: The optimal dose has not been established (Ref). Also, the optimal QRS threshold at which to initiate therapy has not been established; some experts recommend initiating therapy if the QRS interval is >100 msec (Ref), whereas others state a threshold of >120 msec (Ref). Consultation with a clinical toxicologist or poison control center is highly recommended.

Initial : IV: 50 to 100 mEq or 1 to 2 mEq/kg over 1 to 2 minutes; repeat as needed to achieve narrowing of the QRS interval while maintaining a blood pH of 7.45 to 7.55. May initiate a continuous infusion following initial bolus therapy (Ref).

Continuous infusion: IV: Following initial bolus therapy, initiate a continuous infusion using sodium bicarbonate (8.4%) 150 mEq in 1 L D5W. Administer at a rate of ~150 mL/hour to maintain a serum pH of 7.45 to 7.55. Avoid fluid overload (Ref).

Hyperkalemia, severe/emergent

Hyperkalemia , severe/emergent (adjunctive agent) (off-label use): Note: Practice may vary; refer to institutional protocols.

Hyperkalemia with cardiac arrest: Intermittent bolus: IV: 50 mEq over 5 minutes (Ref).

Hyperkalemia with metabolic acidosis: Note: May consider in patients with persistent severe hyperkalemia and/or ECG changes despite calcium and other therapies to decrease serum potassium, particularly in patients with metabolic acidosis (Ref).

IV: 150 mEq in 1 L of D5W over 2 to 4 hours (Ref).

Metabolic acidosis, acute severe

Metabolic acidosis, acute severe: Note: Must treat underlying cause; the underlying cause and degree of acidosis may result in the need for larger or smaller bicarbonate replacement doses. Consider bicarbonate therapy in patients with either a pH of <7.1 or in patients with severe acute kidney injury and a pH of ≤7.2. In most cases, the initial goal of therapy is to maintain a target pH >7.2 until the primary process causing metabolic acidosis is resolved. In patients with a pH of ≤7.2 and severe acute kidney injury, the initial pH goal is >7.3 (Ref). Optimal dosing, regimens, administration, and monitoring have not been identified; refer to institutional protocols.

Example regimens:

Intermittent therapy: 7.5% or 8.4% sodium bicarbonate: IV: Initial: 89.2 to 100 mEq once over 1 to 2 minutes; reassess pH, serum bicarbonate level, and clinical status every 2 hours. If pH remains below target (~7.2 to 7.3), administer an additional 44.6 to 100 mEq sodium bicarbonate or initiate a continuous infusion (Ref).

Example: 100 mEq of 8.4% sodium bicarbonate once over 1 to 2 minutes, then repeat with 50 to 100 mEq or initiate a continuous infusion if pH remains below target (Ref).

Continuous infusion therapy:

Bicarbonate deficit regimen: Note: Dosing is based on the following bicarbonate deficit formula. This equation provides a very rough estimate of the initial bicarbonate replacement dose; monitor clinical status closely. Some experts prefer intermittent bolus therapy over continuous infusion (Ref).

Continuous infusion: IV: Sodium bicarbonate estimated dose (mEq) = 0.5 × weight (kg) × [goal serum bicarbonate – observed serum bicarbonate (mEq/L)]; generally, goal serum bicarbonate is ~8 to 12 mEq/L (Ref). Note: In the equation above, "0.5 × weight (kg)" represents the estimated bicarbonate Vd.

Note: Administer the calculated amount of bicarbonate (mEq) over several hours (eg, 2 to 4 hours) until pH is ~7.2 to 7.3; reassess pH, serum bicarbonate level, and clinical status every 2 hours, and adjust dose as needed until goals are reached (Ref).

Example: For estimated bicarbonate deficit of 150 mEq, administer sodium bicarbonate [8.4%] 150 mEq in 1 L D5W over 2 to 4 hours, then reassess pH, serum bicarbonate level, and clinical status. Adjust dose if pH remains below target (Ref).

Metabolic acidosis in patients with chronic kidney disease

Metabolic acidosis in patients with chronic kidney disease (off-label dose): Note: Kidney Disease Improving Global Outcomes guidelines suggest oral replacement when plasma HCO3 - concentrations are <22 mEq/L (Ref).

Oral: Initial: 15.4 to 23.1 mEq/day in divided doses (eg, 650 mg tablet 2 to 3 times daily); titrate to normal serum bicarbonate concentrations (eg, 23 to 29 mEq/L, although a more targeted range of 24 to 26 mEq/L has been suggested by observational studies (Ref)) or up to 5,850 mg/day; sodium bicarbonate powder may be used as an alternative in patients who cannot take tablets (Ref). Avoid exceeding serum bicarbonate concentrations >29 mEq/L since this has been associated with increased mortality in patients with chronic kidney disease (Ref).

Neutralize lidocaine with epinephrine dental anesthetic

Neutralize lidocaine with epinephrine dental anesthetic: Neutralizing additive: Mix 10 parts anesthetic (lidocaine with epinephrine) to 1 part 8.4% sodium bicarbonate.

Add 0.18 mL sodium bicarbonate to 1.8 mL cartridge of lidocaine 2% with epinephrine 1:50,000 or 1:100,000.

Add 2 mL sodium bicarbonate to 20 mL vial of lidocaine 2% with epinephrine 1:100,000.

Add 3 mL sodium bicarbonate to 30 mL vial of lidocaine 2% with epinephrine 1:100,000.

Add 5 mL sodium bicarbonate to 50 mL vial of lidocaine 2% with epinephrine 1:100,000.

Prevention of contrast-induced nephropathy

Prevention of contrast-induced nephropathy (off-label use): IV infusion: 154 mEq/L sodium bicarbonate in D5W solution: 3 mL/kg/hour for 1 hour immediately before contrast injection, then 1mL/kg/hour during contrast exposure and for 6 hours after procedure (Ref). Some have described a prophylactic strategy based on patient risk for contrast induced nephropathy and procedure type (Ref). Note: In patients at high risk for renal complications, no benefit was seen with IV sodium bicarbonate over IV sodium chloride in one study; therefore, some consider IV sodium chloride as the preferred option due to lower cost and no need for compounding (Ref).

Renal tubular acidosis

Renal tubular acidosis:

Distal, renal tubular acidosis: Oral: 0.5 to 2 mEq/kg/day in 4 to 5 divided doses. Adjust dose based on response.

Proximal, renal tubular acidosis: Oral: Initial: 5 to 10 mEq/kg/day; maintenance: Increase as required to maintain serum bicarbonate in the normal range.

Urine alkalinization

Urine alkalinization (off-label dose):

Oral: Initial: 48 mEq (4 g), then 12 to 24 mEq (1 to 2 g) every 4 hours; dose should be titrated to desired urinary pH; doses up to 186 mEq/day (15.6 g/day) in patients <60 years of age and 92.9 mEq/day (7.8 g/day) in patients >60 years of age. Administration of 48 mEq (4 g) every 8 hours has also been shown to achieve a urinary pH of at least 7 after a period of 10 hours in one study of healthy volunteers (Ref).

IV (off label): Note: IV administration is recommended for the treatment of specific overdoses (eg, salicylates) (Ref); consultation with a clinical toxicologist or poison control center is highly recommended.

Initial: Note: May consider use of initial bolus doses prior to initiation of a continuous infusion, especially in patients with preexisting acidemia (Ref).

IV: 50 to 100 mEq or 1 to 2 mEq/kg over 1 to 2 minutes; repeat as needed to achieve a urinary pH of 7.5 to 8.5 and a serum pH of 7.45 to 7.55 (Ref). Initiate a continuous infusion following initial bolus therapy (if used) (Ref).

Continuous infusion: IV: Initiate a continuous infusion using sodium bicarbonate (8.4%) 150 mEq in 1 L D5W. Administer at a rate of ~150 mL/hour to maintain a urinary pH of 7.5 to 8.5 and a serum pH of 7.45 to 7.55. Avoid fluid overload (Ref).

Dosing: Kidney Impairment: Adult

The renal dosing recommendations are based upon the best available evidence and clinical expertise. Senior Editorial Team: Bruce Mueller, PharmD, FCCP, FASN, FNKF; Jason A. Roberts, PhD, BPharm (Hons), B App Sc, FSHP, FISAC; Michael Heung, MD, MS.

Note: Contains sodium; use with caution, especially in patients with concomitant hypertension, heart failure, or volume overload (Ref).

Altered kidney function: No dosage adjustment necessary for any degree of kidney dysfunction (Ref).

Hemodialysis, intermittent (thrice weekly): No dosage adjustment necessary (Ref).

Peritoneal dialysis: No dosage adjustment necessary (Ref).

CRRT: No dosage adjustment necessary (Ref).

PIRRT (eg, sustained, low-efficiency diafiltration): No dosage adjustment necessary (Ref).

Dosing: Hepatic Impairment: Adult

There are no dosage adjustments provided in the manufacturer's labeling. Use with caution, especially in clinical states associated with edema and sodium retention.

Dosing: Pediatric

(For additional information see "Sodium bicarbonate: Pediatric drug information")

Note: Dose should be individualized to patient response and target parameters for condition being treated.

Antacid

Antacid: Note: Chronic antacid therapy not recommended for management of gastroesophageal reflux disease in pediatric patients (Ref).

Children ≥6 years and Adolescents: Powder for solution: Oral: 1/2 teaspoonful in 4 ounces of water/dose; may repeat up to every 2 hours; maximum daily dose: 6 doses/day; do not use maximum dose for longer than 2 weeks.

Cardiac arrest

Cardiac arrest (PALS guidelines): Limited data available: Infants, Children, and Adolescents: IV, Intraosseous: 1 mEq/kg/dose; repeat doses should be guided by arterial blood gases; per the manufacturer, the 4.2% (0.5 mEq/mL) solution may be preferred in infants and children <2 years of age. Note: If intraosseous route is used for administration and is subsequently used to obtain blood samples for acid-base analysis, results will be inaccurate (Ref).

Note: Routine use of sodium bicarbonate (NaHCO3) in cardiac arrest is not recommended. May be considered in the setting of prolonged cardiac arrest only after adequate alveolar ventilation has been established and effective cardiac compressions. Sodium bicarbonate may be indicated in some cardiac arrest situations (eg, hyperkalemia, sodium channel blocker toxicity [eg, tricyclic antidepressant overdose]) (Ref).

Chronic kidney disease acidosis

Chronic kidney disease (CKD) acidosis: Limited data available: Note: Initiate if serum bicarbonate <22 mEq/L:

Infants, Children, and Adolescents: Oral: Initial dose based on serum bicarbonate levels (see following equation); calculate the deficit to determine dose needed; may divide dose for tolerability; adjust dose to maintain serum bicarbonate within the targeted normal range (eg, children: 22 to 23 mEq/L; adults: 24 to 25 mEq/L); undertreatment should be avoided due to negative effects of acidosis on growth (Ref).

HCO3 - (mEq) deficit = 0.5 × weight (kg) × [desired HCO3 - (mEq/L) − measured serum HCO3 - (mEq/L)]

Hyperkalemia; adjunct

Hyperkalemia; adjunct: Limited data available; efficacy results variable: Infants, Children, and Adolescents: IV or Intraosseous: 1 to 2 mEq/kg/dose (maximum dose: 50 mEq/dose) has been used to redistribute extracellular potassium into cells; not recommended for routine use for cardiac arrest (Ref).

Metabolic acidosis, acute

Metabolic acidosis, acute: Limited data available:

Blood-gas directed dosing (equations): Infants, Children, and Adolescents: IV: These equations provide an estimated replacement dose. The underlying cause and degree of acidosis may result in the need for larger or smaller replacement doses. In most cases, the initial goal of therapy is to target a pH of ~7.2 to prevent overalkalinization (Ref).

HCO3 - (mEq) deficit = 0.3 × weight (kg) × base deficit (mEq/L) or

HCO3 - (mEq) deficit = 0.3 to 0.5 × weight (kg) × [desired HCO3 - (mEq/L) − measured serum HCO3 - (mEq/L)]

Weight-directed dosing (if acid-base status is not available): Infants, Children, and Adolescents: IV, Intraosseous: 0.5 to 1 mEq/kg/dose over 5 to 15 minutes; maximum dose: 50 mEq/dose (Ref). Subsequent doses should be based on patient's acid-base status.

Neutralization local anesthetic, dental

Neutralization local anesthetic (lidocaine with epinephrine), dental:

Children and Adolescents: Neutralizing additive: Mix 10 parts anesthetic (lidocaine with epinephrine) to 1 part 8.4% sodium bicarbonate.

Add 0.18 mL 8.4% sodium bicarbonate to 1.8 mL cartridge of lidocaine 2% with epinephrine 1:50,000 or 1:100,000.

Add 2 mL 8.4% sodium bicarbonate to 20 mL vial of lidocaine 2% with epinephrine 1:100,000.

Add 3 mL 8.4% sodium bicarbonate to 30 mL vial of lidocaine 2% with epinephrine 1:100,000.

Add 5 mL 8.4% sodium bicarbonate to 50 mL vial of lidocaine 2% with epinephrine 1:100,000.

Overdose, sodium channel blocker

Overdose, sodium channel blocker (eg, tricyclic antidepressant [TCA]): Limited data available:

Infants, Children, and Adolescents: IV: 1 to 2 mEq/kg/dose; may repeat in 5 minutes if no response, followed by continuous IV infusion of 150 mEq NaHCO3/L solution to maintain targeted pH. Note: Goal pH of 7.5 to 7.55 is recommended in TCA poisoning with hypotension, widened QRS interval >100 ms, or ventricular arrhythmia (Ref).

Renal tubular acidosis

Renal tubular acidosis (RTA): Limited data available: Note: Dose should be individualized based on urinary bicarbonate excretion (degree depends on type of RTA), serum bicarbonate, and possibly age-related factors.

Infants, Children, and Adolescents:

Distal; type 1: Oral: Usual dose: 3 to 4 mEq bicarbonate/kg/day in divided doses; titrate to maintain normal electrolyte concentrations; younger patients require more bicarbonate replacement due to acid production during growth; some data suggest infants require a higher dose of 5 to 10 mEq bicarbonate/kg/day and growing children need 4 to 8 mEq bicarbonate/kg/day (Ref).

Proximal, type 2: Oral: Usual dose: 10 to 15 mEq/kg/day in divided doses; titrate as necessary to maintain normal electrolyte concentrations; doses as high as 20 mEq bicarbonate/kg/day have been described (Ref).

Skin protectant; relief of minor irritation

Skin protectant; relief of minor irritation: Note: Notify physician if no symptom resolution within 14 days, or if symptoms reappear after an initial resolution.

Children ≥2 years and Adolescents: Topical: Powder for solution (baking soda):

Bath soak: Topical: Dissolve 1 to 2 cups of powder in tub of warm water and soak for 10 to 30 minutes; pat skin dry (do not rub).

Compress or wet dressing: Topical: Mix powder with water; soak clean, soft cloth in mixture and apply cloth loosely to affected area for 15 to 30 minutes; may repeat as needed or as directed by physician.

Paste: Topical: Mix powder with water to form a paste and apply to the affected area of skin as needed.

Dosing: Kidney Impairment: Pediatric

There are no dosage adjustments provided in the manufacturer's labeling. Use with caution; can cause sodium retention.

Dosing: Hepatic Impairment: Pediatric

There are no dosage adjustments provided in the manufacturer's labeling. Use with caution, especially in clinical states associated with edema and sodium retention.

Dosing: Older Adult

Refer to adult dosing.

Dosage Forms: US

Excipient information presented when available (limited, particularly for generics); consult specific product labeling.

Powder, Oral:

Generic: (1 g, 120 g, 454 g, 500 g, 1000 g, 2500 g, 10000 g, 12000 g, 24000 g, 25000 g, 45000 g)

Solution, Intravenous:

Generic: 4.2% (5 mL, 10 mL); 8.4% (10 mL, 50 mL)

Solution, Intravenous [preservative free]:

Generic: 4.2% (5 mL); 7.5% (50 mL); 8.4% (50 mL)

Tablet, Oral:

Generic: 325 mg, 650 mg

Generic Equivalent Available: US

Yes

Dosage Forms Considerations

Sodium bicarbonate solution 4.2% [42 mg/mL] provides 0.5 mEq/mL each of sodium and bicarbonate

Sodium bicarbonate solution 7.5% [75 mg/mL] provides 0.9 mEq/mL each of sodium and bicarbonate

Sodium bicarbonate solution 8.4% [84 mg/mL] provides 1 mEq/mL each of sodium and bicarbonate

Dosage Forms: Canada

Excipient information presented when available (limited, particularly for generics); consult specific product labeling.

Solution, Intravenous:

Generic: 4.2% (10 mL); 7.5% (50 mL); 8.4% (10 mL, 50 mL)

Administration: Adult

IV: For direct IV infusion in emergencies, administer slowly; for infusion, dilute to a maximum concentration of 0.5 mEq/mL in dextrose solution and infuse over at least 2 hours (maximum rate of administration: 1 mEq/kg/hour).

Vesicant (at concentrations ≥8.4%); ensure proper needle or catheter placement prior to and during IV infusion. Avoid extravasation.

Extravasation management: If extravasation occurs, stop infusion immediately and disconnect (leave needle/cannula in place); gently aspirate extravasated solution (do NOT flush the line); initiate hyaluronidase antidote; remove needle/cannula; apply dry cold compresses (Ref); elevate extremity.

Hyaluronidase: Intradermal or SUBQ: Inject a total of 1 to 1.7 mL (15 units/mL) as five separate 0.2 to 0.3 mL injections (using a 25-gauge needle) into area of extravasation at the leading edge in a clockwise manner (Ref).

Oral:

Powder: Do not administer when overly full from food or drink. Dissolve ½ teaspoonful of powder completely in 120 mL of water prior to administering.

Tablet: Do not administer when overly full from food or drink. May be swallowed whole or dissolved completely in a glass of water prior to administering. Administration instructions differ by product; refer to product-specific labeling for additional administration instructions.

Infiltration (dental use; Onpharma): Add specified volume of 8.4% sodium bicarbonate directly with lidocaine and epinephrine injection and mix; use immediately after mixing.

Administration: Pediatric

Oral:

Powder for solution (baking soda): Measure dose exactly, mix with adequate amount of water (eg, 1/2 teaspoon powder with 4 ounces of water), allow to dissolve completely prior to administration.

Neutralizing additive (dental use): Add specified volume of 8.4% sodium bicarbonate directly with lidocaine and epinephrine injection and mix; use immediately after mixing.

Parenteral:

Direct IV injection:

Neonates and Infants: Administer 0.5 mEq/mL solution; infusion rate depends upon indication, see dosing (Ref).

Children and Adolescents: Administer 1 mEq/mL solution; infusion rate depends upon indication, see dosing; maximum rate: 10 mEq/minute (Ref).

IV infusion: Infusion time variable based upon indication; may be added to IV fluids for infusion when urgent correction is not needed; for metabolic acidosis, infusions over 4 to 8 hours have been suggested (Ref); in neonates, the maximum rate of administration: 1 mEq/kg/hour (Ref).

Vesicant (at concentrations ≥8.4%); ensure proper needle or catheter placement prior to and during IV infusion. Avoid extravasation. If extravasation occurs, stop infusion immediately and disconnect (leave needle/cannula in place); gently aspirate extravasated solution (do NOT flush the line); initiate hyaluronidase antidote (see "Management of Drug Extravasations" for more details); remove needle/cannula; apply dry cold compresses (Ref); elevate extremity.

Topical: Paste, compress/dressing: Apply to clean affected area.

Use: Labeled Indications

Antacid: Relief of acid indigestion, heartburn, sour stomach, and upset stomach.

Metabolic acidosis: Management of metabolic acidosis.

Neutralizing additive (IV use): To reduce the incidence of chemical phlebitis and patient discomfort due to vein irritation at or near the infusion site by raising the pH of IV acid solutions.

Neutralizing additive (dental use): Improves onset of analgesia and reduces injection site pain by adjusting lidocaine with epinephrine solution to a more physiologic pH.

Urine alkalinization: Alkalinization agent for urine, including management of specific overdoses (eg, salicylates).

Use: Off-Label: Adult

Cardiac conduction delays due to sodium channel blockade in overdose; Contrast-induced nephropathy (prevention); Hyperkalemia, severe/emergent

Adverse Reactions

The following adverse drug reactions and incidences are derived from product labeling unless otherwise specified.

Frequency not defined.

Cardiovascular: Cardiac failure (exacerbation), edema

Central nervous system: Cerebral hemorrhage

Endocrine & metabolic: Acidosis (intracranial), hypernatremia, hypocalcemia, hypokalemia, metabolic alkalosis, milk-alkali syndrome (especially with renal dysfunction)

Gastrointestinal: Abdominal distention, eructation, flatulence (oral administration)

Neuromuscular & skeletal: Tetany

Respiratory: Pulmonary edema

Contraindications

Injection: Chloride loss due to vomiting or from continuous GI suction; concomitant use of diuretics known to produce a hypochloremic alkalosis.

Neutralizing additive (dental or IV use): Not for use as a systemic alkalizer.

OTC labeling: When used for self-medication, do not use if on low-sodium diet.

Warnings/Precautions

Concerns related to adverse effects:

• Extravasation: Vesicant (at concentrations ≥8.4%); ensure proper catheter or needle position prior to and during infusion. Avoid extravasation (tissue necrosis may occur due to hypertonicity and alkalinity) (Ong 2020).

Disease-related concerns:

• Cirrhosis: Use with caution in patients with cirrhosis.

• Edema: Use with caution in patients with edema.

• Heart failure: Use with caution in patients with heart failure.

• Peptic ulcer disease: Not to be used in treatment of peptic ulcer disease.

• Kidney impairment: Use with caution in patients with kidney impairment; may cause sodium retention.

Special populations:

• Older adult: Not the antacid of choice for the older adults because of sodium content and potential for systemic alkalosis.

• Pediatric: Rapid administration in neonates, infants, and children <2 years of age has led to hypernatremia, decreased CSF pressure, and intracranial hemorrhage.

Dosage form specific issues:

• Injection: Use of IV sodium bicarbonate should be reserved for documented severe metabolic acidosis and for severe/emergent hyperkalemia (eg, cardiotoxicity or cardiac arrest). Routine use in cardiac arrest is not recommended.

• Powder/Tablets: Completely dissolve in water prior to administration; severe stomach irritation may occur.

Other warnings/precautions:

• Self-medication (OTC use): Antacid: When used for self-medication (OTC), ask health care provider prior to use if on a sodium-restricted diet. Discontinue use and notify health care provider if the maximum dosage has been used for 2 weeks or severe abdominal pain occurs with use. Do not administer when overly full from food or drink.

Metabolism/Transport Effects

None known.

Drug Interactions

Note: Interacting drugs may not be individually listed below if they are part of a group interaction (eg, individual drugs within “CYP3A4 Inducers [Strong]” are NOT listed). For a complete list of drug interactions by individual drug name and detailed management recommendations, use the Lexicomp drug interactions program by clicking on the “Launch drug interactions program” link above.

Acalabrutinib: Antacids may decrease the serum concentration of Acalabrutinib. Management: Separate administration of acalabrutinib capsules from the administration of any antacid by at least 2 hours in order to minimize the potential for a significant interaction. Acalabrutinib tablets are not expected to interact with antacids. Risk D: Consider therapy modification

AcetaZOLAMIDE: May enhance the adverse/toxic effect of Sodium Bicarbonate. Specifically, the risk of renal calculus formation may be increased. Risk C: Monitor therapy

Alpha-/Beta-Agonists (Indirect-Acting): Alkalinizing Agents may increase the serum concentration of Alpha-/Beta-Agonists (Indirect-Acting). Risk C: Monitor therapy

Amantadine: Alkalinizing Agents may increase the serum concentration of Amantadine. Risk C: Monitor therapy

Amphetamines: Alkalinizing Agents may decrease the excretion of Amphetamines. Management: Consider alternatives to using amphetamines and alkalinizing agents in combination. If these agents must be used together, patients should be monitored closely for excessive amphetamine effects. Risk D: Consider therapy modification

Antipsychotic Agents (Phenothiazines): Antacids may decrease the absorption of Antipsychotic Agents (Phenothiazines). Risk C: Monitor therapy

Atazanavir: Antacids may decrease the absorption of Atazanavir. Management: Administer antacids 1 to 2 hours before or 2 hours after atazanavir to minimize the risk of a clinically significant interaction. Risk D: Consider therapy modification

Belumosudil: Antacids may decrease the serum concentration of Belumosudil. Management: Consider separating administration of belumosudil and antacids by 2 hours and monitor for reduced belumosudil efficacy. Risk D: Consider therapy modification

Bisacodyl: Antacids may diminish the therapeutic effect of Bisacodyl. Antacids may cause the delayed-release bisacodyl tablets to release drug prior to reaching the large intestine. Gastric irritation and/or cramps may occur. Management: Antacids should not be used within 1 hour before bisacodyl administration. Risk D: Consider therapy modification

Bismuth Subcitrate: Antacids may diminish the therapeutic effect of Bismuth Subcitrate. Management: Avoid administration of antacids within 30 minutes of bismuth subcitrate (tripotassium bismuth dicitrate) administration. Risk D: Consider therapy modification

Bosutinib: Antacids may decrease the serum concentration of Bosutinib. Management: Administer antacids more than 2 hours before or after bosutinib. Risk D: Consider therapy modification

Bromperidol: Antacids may decrease the absorption of Bromperidol. Risk C: Monitor therapy

Calcium Polystyrene Sulfonate: Antacids may enhance the adverse/toxic effect of Calcium Polystyrene Sulfonate. The combined use of these two agents may result in metabolic alkalosis. Risk C: Monitor therapy

Captopril: Antacids may decrease the serum concentration of Captopril. Risk C: Monitor therapy

Cefditoren: Antacids may decrease the serum concentration of Cefditoren. Risk X: Avoid combination

Cefpodoxime: Antacids may decrease the serum concentration of Cefpodoxime. Risk C: Monitor therapy

Cefuroxime: Antacids may decrease the serum concentration of Cefuroxime. Management: Administer cefuroxime axetil at least 1 hour before or 2 hours after the administration of short-acting antacids. Risk D: Consider therapy modification

Chloroquine: Antacids may decrease the serum concentration of Chloroquine. Management: Separate the administration of antacids and chloroquine by at least 4 hours to minimize any potential negative impact of antacids on chloroquine bioavailability. Risk D: Consider therapy modification

Corticosteroids (Oral): Antacids may decrease the bioavailability of Corticosteroids (Oral). Management: Consider separating doses by 2 or more hours. Budesonide enteric coated tablets could dissolve prematurely if given with drugs that lower gastric acid, with unknown impact on budesonide therapeutic effects. Risk D: Consider therapy modification

Cysteamine (Systemic): Antacids may diminish the therapeutic effect of Cysteamine (Systemic). Risk C: Monitor therapy

Dabigatran Etexilate: Antacids may decrease the serum concentration of Dabigatran Etexilate. Management: Dabigatran etexilate Canadian product labeling recommends avoiding concomitant use with antacids for 24 hours after surgery. In other situations, administer dabigatran etexilate 2 hours prior to antacids. Monitor clinical response to dabigatran therapy. Risk D: Consider therapy modification

Dasatinib: Antacids may decrease the serum concentration of Dasatinib. Management: Simultaneous administration of dasatinib and antacids should be avoided. Administer antacids 2 hours before or 2 hours after dasatinib. Risk D: Consider therapy modification

Delavirdine: Antacids may decrease the serum concentration of Delavirdine. Management: Separate doses of delavirdine and antacids by at least 1 hour. Monitor for decreased delavirdine therapeutic effects with this combination. Risk D: Consider therapy modification

Erlotinib: Antacids may decrease the serum concentration of Erlotinib. Management: Separate the administration of erlotinib and any antacid by several hours in order to minimize the risk of a significant interaction. Risk D: Consider therapy modification

Flecainide: Sodium Bicarbonate may decrease the excretion of Flecainide. Risk C: Monitor therapy

Fosinopril: Antacids may decrease the serum concentration of Fosinopril. Management: The US and Canadian fosinopril manufacturer labels recommend separating the doses of antacids and fosinopril by 2 hours. Risk D: Consider therapy modification

Gefitinib: Antacids may decrease the serum concentration of Gefitinib. Management: Administer gefitinib at least 6 hours before or 6 hours after administration of an antacid, and closely monitor clinical response to gefitinib. Risk D: Consider therapy modification

Hyoscyamine: Antacids may decrease the serum concentration of Hyoscyamine. Management: Administer immediate release hyoscyamine before meals and antacids after meals when these agents are given in combination. Risk D: Consider therapy modification

Infigratinib: Antacids may decrease serum concentrations of the active metabolite(s) of Infigratinib. Antacids may decrease the serum concentration of Infigratinib. Management: Avoid coadministration of infigratinib with antacids or other gastric acid-lowering agents. If antacids cannot be avoided, administer infigratinib 2 hours before or after administration of antacids. Risk D: Consider therapy modification

Iron Preparations: Antacids may decrease the absorption of Iron Preparations. Management: No action is likely necessary for the majority of patients who only use antacids intermittently or occasionally. Consider separating doses of oral iron and antacids in patients who require chronic use of both agents and monitor for reduced iron efficacy. Risk D: Consider therapy modification

Isoniazid: Antacids may decrease the absorption of Isoniazid. Risk C: Monitor therapy

Itraconazole: Antacids may decrease the serum concentration of Itraconazole. Antacids may increase the serum concentration of Itraconazole. Management: Administer Sporanox brand itraconazole at least 2 hours before or 2 hours after administration of any antacids. Exposure to Tolsura brand itraconazole may be increased by antacids; consider itraconazole dose reduction. Risk D: Consider therapy modification

Ketoconazole (Systemic): Antacids may decrease the serum concentration of Ketoconazole (Systemic). Management: Administer antacids at least 1 hour prior to, or 2 hours after, ketoconazole. Additionally, administer ketoconazole with an acidic beverage (eg, non-diet cola) and monitor patients closely for signs of inadequate clinical response to ketoconazole. Risk D: Consider therapy modification

Lanthanum: Antacids may diminish the therapeutic effect of Lanthanum. Management: Administer antacid products at least 2 hours before or after lanthanum. Risk D: Consider therapy modification

Ledipasvir: Antacids may decrease the serum concentration of Ledipasvir. Management: Separate the administration of ledipasvir and antacids by 4 hours. Risk D: Consider therapy modification

Levoketoconazole: Antacids may decrease the absorption of Levoketoconazole. Management: Advise patients to take antacids at least 2 hours after taking levoketoconazole. Risk D: Consider therapy modification

Mecamylamine: Alkalinizing Agents may increase the serum concentration of Mecamylamine. Risk C: Monitor therapy

Memantine: Alkalinizing Agents may increase the serum concentration of Memantine. Risk C: Monitor therapy

Mesalamine: Antacids may diminish the therapeutic effect of Mesalamine. Antacid-mediated increases in gastrointestinal pH may cause the premature release of mesalamine from specific sustained-release mesalamine products. Management: Avoid concurrent administration of antacids with the Apriso brand of mesalamine extended-release capsules. The optimal duration of dose separation is unknown. Other mesalamine products do not contain this interaction warning. Risk D: Consider therapy modification

Methenamine: Antacids may diminish the therapeutic effect of Methenamine. Management: Consider avoiding the concomitant use of medications that alkalinize the urine, such as antacids, and methenamine. Monitor for decreased therapeutic effects of methenamine if used concomitant with antacids. Risk D: Consider therapy modification

Multivitamins/Minerals (with ADEK, Folate, Iron): Antacids may decrease the serum concentration of Multivitamins/Minerals (with ADEK, Folate, Iron). Specifically, antacids may decrease the absorption of orally administered iron. Management: Separate dosing of oral iron-containing multivitamins and antacids by as much time as possible to minimize impact of this interaction. Monitor for decreased therapeutic efficacy of oral iron preparations during coadministration. Risk D: Consider therapy modification

Neratinib: Antacids may decrease the serum concentration of Neratinib. Specifically, antacids may reduce neratinib absorption. Management: Separate the administration of neratinib and antacids by giving neratinib at least 3 hours after the antacid. Risk D: Consider therapy modification

Nilotinib: Antacids may decrease the serum concentration of Nilotinib. Management: Separate the administration of nilotinib and any antacid by at least 2 hours whenever possible in order to minimize the risk of a significant interaction. Risk D: Consider therapy modification

Octreotide: Antacids may decrease the serum concentration of Octreotide. Risk C: Monitor therapy

PAZOPanib: Antacids may decrease the serum concentration of PAZOPanib. Management: Avoid the use of antacids in combination with pazopanib whenever possible. Separate doses by several hours if antacid treatment is considered necessary. The impact of dose separation has not been investigated. Risk D: Consider therapy modification

Pexidartinib: Antacids may decrease the serum concentration of Pexidartinib. Management: Administer pexidartinib at least 2 hours before or 2 hours after antacids. Risk D: Consider therapy modification

Phosphate Supplements: Antacids may decrease the absorption of Phosphate Supplements. Management: This applies only to oral phosphate administration. Separating administration of oral phosphate supplements from antacid administration by as long as possible may minimize the interaction. Risk D: Consider therapy modification

Potassium Phosphate: Antacids may decrease the serum concentration of Potassium Phosphate. Management: Consider separating administration of antacids and oral potassium phosphate by at least 2 hours to decrease risk of a significant interaction. Risk D: Consider therapy modification

QuiNIDine: Alkalinizing Agents may increase the serum concentration of QuiNIDine. Risk C: Monitor therapy

QuiNINE: Alkalinizing Agents may increase the serum concentration of QuiNINE. Risk C: Monitor therapy

Rilpivirine: Antacids may decrease the serum concentration of Rilpivirine. Management: Administer antacids at least 2 hours before or 4 hours after oral rilpivirine when used with most rilpivirine products. However, administer antacids at least 6 hours before or 4 hours after the rilpivirine/dolutegravir combination product. Risk D: Consider therapy modification

Riociguat: Antacids may decrease the serum concentration of Riociguat. Management: Separate the administration of antacids and riociguat by at least 1 hour in order to minimize any potential interaction. Monitor clinical response to riociguat more closely in patients using this combination. Risk D: Consider therapy modification

Rosuvastatin: Antacids may decrease the serum concentration of Rosuvastatin. Risk C: Monitor therapy

Selpercatinib: Antacids may decrease the serum concentration of Selpercatinib. Management: Coadministration of selpercatinib and antacids should be avoided. If coadministration cannot be avoided, selpercatinib should be administered 2 hours before or 2 hours after antacids. Risk D: Consider therapy modification

Sodium Polystyrene Sulfonate: Antacids may enhance the adverse/toxic effect of Sodium Polystyrene Sulfonate. Specifically, the risk of metabolic alkalosis may be increased. Antacids may diminish the therapeutic effect of Sodium Polystyrene Sulfonate. Risk C: Monitor therapy

Sotalol: Antacids may decrease the serum concentration of Sotalol. Management: Avoid simultaneous administration of sotalol and antacids. Administer antacids 2 hours after sotalol. Risk D: Consider therapy modification

Sotorasib: Antacids may decrease the serum concentration of Sotorasib. Management: Avoid coadministration of sotorasib and antacids. If use of a gastric acid suppressing medication cannot be avoided, administer sotorasib 4 hours before or 10 hours after oral antacid administration. Risk D: Consider therapy modification

Sparsentan: Antacids may decrease the serum concentration of Sparsentan. Management: Administer sparsentan 2 hours before or 2 hours after antacids. Risk D: Consider therapy modification

Sulpiride: Antacids may decrease the serum concentration of Sulpiride. Management: Separate administration of antacids and sulpiride by at least 2 hours in order to minimize the impact of antacids on sulpiride absorption. Risk D: Consider therapy modification

Tetracyclines: Antacids may decrease the absorption of Tetracyclines. Management: Separate administration of antacids and oral tetracycline derivatives by several hours when possible to minimize the extent of this potential interaction. Monitor for decreased therapeutic effects of tetracyclines. Risk D: Consider therapy modification

Thyroid Products: Antacids may increase the serum concentration of Thyroid Products. Risk C: Monitor therapy

Velpatasvir: Antacids may decrease the serum concentration of Velpatasvir. Management: Separate administration of velpatasvir and antacids by at least 4 hours. Risk D: Consider therapy modification

Pregnancy Considerations

Medications used for the treatment of cardiac arrest in pregnancy are the same as in the nonpregnant woman. Doses and indications should follow current Advanced Cardiovascular Life Support guidelines. Appropriate medications should not be withheld due to concerns of fetal teratogenicity (Campbell 2009; Jeejeebhoy [AHA] 2015). Antacids containing sodium bicarbonate should not be used during pregnancy due to their potential to cause metabolic alkalosis and fluid overload in the mother and fetus (Body 2016; Dağlı 2017; Gomes 2018; Thélin 2020).

Breastfeeding Considerations

Sodium is found in breast milk (IOM 2004).

Dietary Considerations

Some products may contain sodium. Oral product should be taken 1 to 3 hours after meals.

Monitoring Parameters

Serum electrolytes (including bicarbonate, potassium, sodium, calcium), urinary pH, arterial blood gases (if indicated).

Mechanism of Action

Dissociates to provide bicarbonate ion which neutralizes hydrogen ion concentration and raises blood and urinary pH

Neutralizing additive (dental use): Increases pH of lidocaine and epinephrine solution to improve tolerability and increase tissue uptake

Pharmacokinetics (Adult Data Unless Noted)

Onset of action: Oral: 15 minutes; IV: Rapid

Duration: Oral: 1 to 3 hours; IV: 8 to 10 minutes

Absorption: Oral: Well absorbed

Excretion: Urine (<1%)

Pricing: US

Solution (Sodium Bicarbonate Intravenous)

4.2% (per mL): $1.86 - $4.95

7.5% (per mL): $0.47

8.4% (per mL): $0.15 - $0.52

Tablets (Sodium Bicarbonate Oral)

325 mg (per each): $0.01 - $0.05

650 mg (per each): $0.01 - $0.05

Disclaimer: A representative AWP (Average Wholesale Price) price or price range is provided as reference price only. A range is provided when more than one manufacturer's AWP price is available and uses the low and high price reported by the manufacturers to determine the range. The pricing data should be used for benchmarking purposes only, and as such should not be used alone to set or adjudicate any prices for reimbursement or purchasing functions or considered to be an exact price for a single product and/or manufacturer. Medi-Span expressly disclaims all warranties of any kind or nature, whether express or implied, and assumes no liability with respect to accuracy of price or price range data published in its solutions. In no event shall Medi-Span be liable for special, indirect, incidental, or consequential damages arising from use of price or price range data. Pricing data is updated monthly.

Brand Names: International
  • Betsol "Z" (MX);
  • Bicart (EG);
  • Natribic (BE);
  • Natrium bicarbonicum (PL);
  • Solunate (PH)


For country code abbreviations (show table)
  1. Adrogué HJ. Metabolic acidosis: pathophysiology, diagnosis and management. J Nephrol. 2006;19(suppl 9):S62-S69. [PubMed 16736443]
  2. Adrogué HJ, Madias NE. Management of Life-Threatening Acid-Base Disorders. Second of Two Parts. N Engl J Med. 1998;338(2):107-111. [PubMed 9420343]
  3. Al-Abri SA, Olson KR. Baking soda can settle the stomach but upset the heart: case files of the Medical Toxicology Fellowship at the University of California, San Francisco. J Med Toxicol. 2013;9(3):255-258. [PubMed 23591957]
  4. American Society of Health-System Pharmacists (ASHP). Pediatric continuous infusion standards. Available at https://www.ashp.org/-/media/assets/pharmacy-practice/s4s/docs/Pediatric-Infusion-Standards.ashx. Updated January 2021. Accessed February 15, 2022.
  5. Arm and Hammer Baking Soda (sodium bicarbonate) [prescribing information]. Ewing, NJ: Church & Dwight; January 2022.
  6. Aschner JL, Poland RL. Sodium Bicarbonate: Basically Useless Therapy. Pediatrics. 2008;122(4):831-835. [PubMed 18829808]
  7. Barry JD. Antimalarials. In: Nelson LS, Howland MA, Lewin NA, Smith SW, Goldfrank LR, Hoffman RS, eds. Goldfrank's Toxicologic Emergencies. 11th ed. McGraw-Hill; 2019.
  8. Blumberg A, Weidmann P, Ferrari P. Effect of prolonged bicarbonate administration on plasma potassium in terminal renal failure. Kidney Int. 1992;41(2):369-374. doi:10.1038/ki.1992.51 [PubMed 1552710]
  9. Body C, Christie JA. Gastrointestinal diseases in pregnancy: nausea, vomiting, hyperemesis gravidarum, gastroesophageal reflux disease, constipation, and diarrhea. Gastroenterol Clin North Am. 2016;45(2):267‐283. doi:10.1016/j.gtc.2016.02.005 [PubMed 27261898]
  10. Bradberry SM, Thanacoody HK, Watt BE, Thomas SH, Vale JA. Management of the cardiovascular complications of tricyclic antidepressant poisoning: role of sodium bicarbonate. Toxicol Rev. 2005;24(3):195-204. doi:10.2165/00139709-200524030-00012 [PubMed 16390221]
  11. Brar SS, Hiremath S, Dangas G, Mehran R, Brar SK, Leon MB. Sodium bicarbonate for the prevention of contrast induced-acute kidney injury: a systematic review and meta-analysis. Clin J Am Soc Nephrol. 2009;4(10):1584-1592. doi:10.2215/CJN.03120509 [PubMed 19713291]
  12. Bruccoleri RE, Burns MM. A literature review of the use of sodium bicarbonate for the treatment of QRS widening. J Med Toxicol. 2016;12(1):121-129. doi:10.1007/s13181-015-0483-y [PubMed 26159649]
  13. Brucculeri M, Kaplan J, Lande L. Reversal of citalopram-induced junctional bradycardia with intravenous sodium bicarbonate. Pharmacotherapy. 2005;25(1):119-122. doi:10.1592/phco.25.1.119.55630 [PubMed 15767228]
  14. Campbell TA, Sanson TG. Cardiac Arrest and Pregnancy. J Emerg Trauma Shock. 2009;2(1):34-42. [PubMed 19561954]
  15. Carrillo-Lopez H, Chavez A, Jarillo A. Acid-base disorders. In: Fuhrman B, Zimmerman J, eds. Pediatric Critical Care. 5th ed. Elsevier Health; 2017:chap. 76.
  16. Chan JC, Scheinman JI, Roth KS. Consultation with the specialist: renal tubular acidosis. Pediatr Rev. 2001;22(8):277-287. [PubMed 11483854]
  17. Chen W, Abramowitz MK. Treatment of metabolic acidosis in patients with CKD. Am J Kidney Dis. 2014;63(2):311-317. doi:10.1053/j.ajkd.2013.06.017 [PubMed 23932089]
  18. Clase CM, Carrero JJ, Ellison DH, et al; Conference Participants. Potassium homeostasis and management of dyskalemia in kidney diseases: conclusions from a Kidney Disease: Improving Global Outcomes (KDIGO) Controversies Conference. Kidney Int. 2020;97(1):42-61. doi:10.1016/j.kint.2019.09.018 [PubMed 31706619]
  19. Cohen B, Laish I, Brosh-Nissimov T, et al. Efficacy of urine alkalinization by oral administration of sodium bicarbonate: a prospective open-label trial. Am J Emerg Med. 2013;31(12):1703-1706. [PubMed 24055481]
  20. Dağlı Ü, Kalkan İH. Treatment of reflux disease during pregnancy and lactation. Turk J Gastroenterol. 2017;28(suppl 1):S53‐S56. doi:10.5152/tjg.2017.14 [PubMed 29199169]
  21. Dobre M, Yang W, Pan Q, et al; CRIC Study Investigators. Persistent high serum bicarbonate and the risk of heart failure in patients with chronic kidney disease (CKD): a report from the Chronic Renal Insufficiency Cohort (CRIC) study. J Am Heart Assoc. 2015;4(4):e001599. doi:10.1161/JAHA.114.001599 [PubMed 25896890]
  22. Doherty EG. Fluid and electrolyte management. In: Eichenwald EC, Hansen AR, Martin CR, Stark AR. Cloherty and Stark's Manual of Neonatal Care. 8th edition. Lippincott Williams & Wilkins; 2017:chap 23.
  23. Domonoske C. Appendix A: Common neonatal intensive care unit (NICU) medication guidelines. In: Eichenwald EC, Hansen AR, Martin CR, Stark AR. Cloherty and Stark's Manual of Neonatal Care. 8th edition. Lippincott Williams & Wilkins; 2017.
  24. Engebretsen KM, Harris CR, Wood JE. Cardiotoxicity and late onset seizures with citalopram overdose. J Emerg Med. 2003;25(2):163-166. doi:10.1016/s0736-4679(03)00164-1 [PubMed 12902002]
  25. Emmett M, Szerlip H. Approach to the adult with metabolic acidosis. Post TW, ed. UpToDate. Waltham, MA: UpToDate Inc. https://www.uptodate.com. Accessed November 23, 2021.
  26. Evans L, Rhodes A, Alhazzani W, et al. Surviving sepsis campaign: international guidelines for management of sepsis and septic shock 2021. Intensive Care Med. 2021;47(11):1181-1247. doi:10.1007/s00134-021-06506-y [PubMed 34599691]
  27. Expert opinion. Senior Renal Editorial Team: Bruce Mueller, PharmD, FCCP, FASN, FNKF; Jason A. Roberts, PhD, BPharm (Hons), B App Sc, FSHP, FISAC; Michael Heung, MD, MS.
  28. Fuhrman B, Zimmerman J, eds. Pediatric Critical Care. 4th ed. Elsevier; 2011.
  29. Giglio S, Montini G, Trepiccione F, Gambaro G, Emma F. Distal renal tubular acidosis: a systematic approach from diagnosis to treatment. J Nephrol. 2021;34(6):2073-2083. doi:10.1007/s40620-021-01032-y [PubMed 33770395]
  30. Goldfarb S, McCullough PA, McDermott J, Gay SB. Contrast-induced acute kidney injury: specialty-specific protocols for interventional radiology, diagnostic computed tomography radiology, and interventional cardiology. Mayo Clin Proc. 2009;84(2):170-179. [PubMed 19181651]
  31. Gomes CF, Sousa M, Lourenço I, Martins D, Torres J. Gastrointestinal diseases during pregnancy: what does the gastroenterologist need to know?. Ann Gastroenterol. 2018;31(4):385‐394. doi:10.20524/aog.2018.0264 [PubMed 29991883]
  32. Howland MA. Antidotes in depth: sodium bicarbonate. In: Nelson LS, Howland MA, Lewin NA, Smith SW, Goldfrank LR, Hoffman RS, eds. Goldfrank's Toxicologic Emergencies. 11th ed. McGraw-Hill; 2019. [PubMed 18245435]
  33. Hurst S, McMillan M. Innovative solutions in critical care units: extravasation guidelines. Dimens Crit Care Nurs. 2004;23(3):125-128. [PubMed 15192356]
  34. IOM (Institute of Medicine). Dietary Reference Intakes for Water, Potassium, Sodium, Chloride, and Sulfate. National Academy Press; 2004.
  35. Jaber S, Paugam C, Futier E, et al. Sodium bicarbonate therapy for patients with severe metabolic acidaemia in the intensive care unit (BICAR-ICU): a multicentre, open-label, randomised controlled, phase 3 trial. Lancet. 2018;392(10141):31-40. doi:10.1016/S0140-6736(18)31080-8 [PubMed 29910040]
  36. Jeejeebhoy FM, Zelop CM, Lipman S, et al; American Heart Association Emergency Cardiovascular Care Committee, Council on Cardiopulmonary, Critical Care, Perioperative and Resuscitation, Council on Cardiovascular Diseases in the Young, and Council on Clinical Cardiology. Cardiac Arrest in Pregnancy: A Scientific Statement From the American Heart Association. Circulation. 2015;132(18):1747-1773. doi:10.1161/CIR.0000000000000300 [PubMed 26443610]
  37. Kaspar CDW, Bunchman TE. Glomerulotubular dysfunction and acute kidney injury. In: Fuhrman B, Zimmerman J, eds. Pediatric Critical Care. 5th ed. Elsevier Health; 2017:chap. 75.
  38. Kleinman ME, Chameides L, Schexnayder SM, et al. Part 14: Pediatric Advanced Life Support: 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation, 2010;122(18)(suppl 3):876-908. [PubMed 20956230]
  39. Kidney Disease Improving Global Outcomes (KDIGO). 2012 clinical practice guideline for the evaluation and management of chronic kidney disease. Kidney Int Suppl. 2013;3(suppl 1):1-150. http://www.kidney-international.org. Published January 2013.
  40. Kidney Disease: Improving Global Outcomes (KDIGO) Acute Kidney Injury Work Group. KDIGO clinical practice guideline for acute kidney injury. Kidney Int Suppl. 2012;2(suppl 1):1-138. https://kdigo.org/wp-content/uploads/2016/10/KDIGO-2012-AKI-Guideline-English.pdf. Published March 2012. Accessed March 15, 2017.
  41. Kovesdy CP, Anderson JE, Kalantar-Zadeh K. Association of serum bicarbonate levels with mortality in patients with non-dialysis-dependent CKD. Nephrol Dial Transplant. 2009;24(4):1232-1237. doi:10.1093/ndt/gfn633 [PubMed 19015169]
  42. Kraut JA, Madias NE. Consequences and therapy of the metabolic acidosis of chronic kidney disease. Pediatr Nephrol. 2011;26(1):19-28. [PubMed 20526632]
  43. Kraut JA, Madias NE. Treatment of acute metabolic acidosis: a pathophysiologic approach. Nat Rev Nephrol. 2012;8(10):589-601. doi:10.1038/nrneph.2012.186 [PubMed 22945490]
  44. Liebelt EL. Targeted management strategies for cardiovascular toxicity from tricyclic antidepressant overdose: the pivotal role for alkalinization and sodium loading. Pediatr Emerg Care. 1998;14(4):293-298. [PubMed 9733258]
  45. Lightdale JR, Gremse DA, Section on Gastroenterology, Hepatology, and Nutrition. Gastroesophageal reflux: management guidance for the pediatrician. Pediatrics. 2013;131(5):e1684-e1695. [PubMed 23629618]
  46. Lindner G, Burdmann EA, Clase CM, et al. Acute hyperkalemia in the emergency department: a summary from a Kidney Disease: Improving Global Outcomes conference. Eur J Emerg Med. 2020;27(5):329-337. doi:10.1097/MEJ.0000000000000691 [PubMed 32852924]
  47. Lokesh L, Kumar P, Murki S, et al. A Randomized Controlled Trial of Sodium Bicarbonate in Neonatal Resuscitation-Effect on Immediate Outcome. Resuscitation. 2004;60(2):219-223. [PubMed 15036741]
  48. Medis Sodium Bicarbonate (sodium bicarbonate) [prescribing information]. Texarkana, TX: Humco: June 2020.
  49. Merten GJ, Burgess WP, Gray LV, et al. Prevention of contrast-induced nephropathy with sodium bicarbonate: a randomized controlled trial. JAMA. 2004;291(19):2328-2334. doi:10.1001/jama.291.19.2328 [PubMed 15150204]
  50. Mount DB. Treatment and prevention of hyperkalemia in adults. Post TW, ed. UpToDate. Waltham, MA: UpToDate Inc. http://www.uptodate.com. Accessed November 9, 2021.
  51. Murki S, Kumar P, Lingappa L, et al. Effect of a Single Dose of Sodium Bicarbonate Given During Neonatal Resuscitation at Birth on the Acid-Base Status on First Day of Life. J Perinatol. 2004;24(11):696-699. [PubMed 15318251]
  52. Neumar RW, Otto CW, Link MS, et al. Part 8: adult advanced cardiovascular life support: 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation. 2010;122(18 Suppl 3):S729-S767. doi:10.1161/CIRCULATIONAHA.110.970988 [PubMed 20956224]
  53. Neut (sodium bicarbonate) [prescribing information]. Lake Forest, IL: Hospira; June 2018.
  54. Novaplus sodium bicarbonate injection [prescribing information]. Lake Forest, IL: Hospira Inc; 2013.
  55. Ong J, Van Gerpen R. Recommendations for management of noncytotoxic vesicant extravasations. J Infus Nurs. 2020;43(6):319-343. doi:10.1097/NAN.0000000000000392 [PubMed 33141794]
  56. Ozcan EE, Guneri S, Akdeniz B, et al. Sodium bicarbonate, N-acetylcysteine, and saline for prevention of radiocontrast-induced nephropathy. A comparison of 3 regimens for protecting contrast-induced nephropathy in patients undergoing coronary procedures. A single-center prospective controlled trial. Am Heart J. 2007;154(3):539-544. doi:10.1016/j.ahj.2007.05.012 [PubMed 17719303]
  57. Panchal AR, Bartos JA, Cabañas JG, et al; Adult basic and advanced life support writing group. Part 3: adult basic and advanced life support: 2020 American Heart Association guidelines for cardiopulmonary resuscitation and emergency cardiovascular care. Circulation. 2020;142(16)(suppl 2):S366-S468. doi:10.1161/CIR.0000000000000916 [PubMed 33081529]
  58. Proudfoot AT, Krenzelok EP, Vale JA. Position Paper on urine alkalinization. J Toxicol Clin Toxicol. 2004;42(1):1-26. doi:10.1081/clt-120028740 [PubMed 15083932]
  59. Raphael KL. Approach to the Treatment of Chronic Metabolic Acidosis in CKD. Am J Kidney Dis. 2016;67(4):696-702. [PubMed 26776539]
  60. Raphael KL. Metabolic acidosis in CKD: core curriculum 2019. Am J Kidney Dis. 2019;74(2):263-275. doi:10.1053/j.ajkd.2019.01.036 [PubMed 31036389]
  61. Refer to manufacturer's labeling.
  62. Reynolds PM, MacLaren R, Mueller SW, Fish DN, Kiser TH. Management of extravasation injuries: a focused evaluation of noncytotoxic medications. Pharmacotherapy. 2014;34(6):617-632. [PubMed 24420913]
  63. Richards JR, Garber D, Laurin EG, et al. Treatment of cocaine cardiovascular toxicity: a systematic review. Clin Toxicol (Phila). 2016;54(5):345-364. doi:10.3109/15563650.2016.1142090 [PubMed 26919414]
  64. Rodríguez Soriano J. Renal tubular acidosis: the clinical entity. J Am Soc Nephrol. 2002;13(8):2160-2170. [PubMed 12138150]
  65. Rodríguez-Soriano J, Vallo A, Castillo G, Oliveros R. Natural history of primary distal renal tubular acidosis treated since infancy. J Pediatr. 1982;101(5):669-676. [PubMed 7131138]
  66. Rosen R, Vandenplas Y, Singendonk M, et al. Pediatric Gastroesophageal Reflux clinical practice guidelines: joint recommendations of the North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition and the European Society for Pediatric Gastroenterology, Hepatology, and Nutrition. J Pediatr Gastroenterol Nutr. 2018;66(3):516-554. doi:10.1097/MPG.0000000000001889 [PubMed 29470322]
  67. Rosner MH. Prevention of contrast-associated acute kidney injury. N Engl J Med. 2018;378(7):671-672. doi:10.1056/NEJMe1715190 [PubMed 29443675]
  68. Sabatini S, Kurtzman NA. Bicarbonate therapy in severe metabolic acidosis. J Am Soc Nephrol. 2009;20(4):692-695. doi:10.1681/ASN.2007121329 [PubMed 18322160]
  69. Santos F, Chan JC. Renal tubular acidosis in children. Diagnosis, treatment and prognosis. Am J Nephrol. 1986;6(4):289-295. [PubMed 3777038]
  70. Sharma AN, Hexdall AH, Chang EK, Nelson LS, Hoffman RS. Diphenhydramine-induced wide complex dysrhythmia responds to treatment with sodium bicarbonate. Am J Emerg Med. 2003;21(3):212-215. doi:10.1016/s0735-6757(02)42248-6 [PubMed 12811715]
  71. Shenoi RP, Timm N; Committee on Drugs; Committee on Pediatric Emergency Medicine. Drugs Used to Treat Pediatric Emergencies. Pediatrics. 2020;145(1):e20193450. [PubMed 31871244]
  72. Sodium bicarbonate 5 gr [prescribing information]. Duluth, GA: Rugby Laboratories Inc; 2014.
  73. Sodium bicarbonate injection [prescribing information]. El Monte, CA: International Medication Systems Ltd; January 2008.
  74. Sodium bicarbonate injection [prescribing information]. El Monte, CA: International Medication Systems Ltd; September 2017.
  75. Sodium bicarbonate injection, solution [prescribing information]. Lake Forest, IL: Hospira Inc; January 2018.
  76. Sodium bicarbonate injection, solution 4.2% syringe [prescribing information]. Lake Forest, IL: Hospira Inc; January 2018.
  77. Sodium bicarbonate injection, solution 4.2% vial [prescribing information]. Lake Forest, IL: Hospira Inc; February 2018.
  78. Sodium bicarbonate injection, solution 4.2% and 8.4% vial [prescribing information]. Lake Zurich, IL: Fresenius Kabi; June 2017.
  79. Sodium bicarbonate injection, solution 4.2%, 5%, 7.5%, and 8.4% [prescribing information]. Lake Forest, IL: Hospira Inc; October 2010.
  80. Sodium bicarbonate injection, solution 8.4% vial [prescribing information]. Lake Forest, IL: Hospira Inc; May 2018.
  81. Sodium bicarbonate injection, solution 8.4% syringe [prescribing information]. Lake Forest, IL: Hospira Inc; January 2018.
  82. Sodium bicarbonate injection, solution 7.5% and 8.4% syringe [prescribing information]. Lake Forest, IL: Hospira Inc; January 2018.
  83. Sodium bicarbonate neutralizing additive solution [prescribing information]. Los Gatos, CA: Onpharma; November 2011.
  84. Sodium bicarbonate oral powder [prescribing information]. Paramount, CA: DLC Laboratories; September 2020.
  85. Sodium bicarbonate tablets 325 mg [prescribing information]. Livonia, MI: Rugby Laboratories; November 201.
  86. Sodium bicarbonate tablets 650 mg [prescribing information]. Davidson, NC: GenDose Pharmaceuticals; received April 2020.
  87. Soleimani M, Rastegar A. Pathophysiology of renal tubular acidosis: core curriculum 2016. Am J Kidney Dis. 2016;68(3):488-498. doi:10.1053/j.ajkd.2016.03.422 [PubMed 27188519]
  88. Stacul F, van der Molen AJ, Reimer P, et al; Contrast Media Safety Committee of European Society Urogenital Radiology (ESUR). Contrast induced nephropathy: updated ESUR Contrast Media Safety Committee guidelines. Eur Radiol. 2011;21(12):2527-2541. doi:10.1007/s00330-011-2225-0 [PubMed 21866433]
  89. Taal MW, Chertow GM, Marsden PA, Skorecki K, Yu ASL, Brenner BA, eds. Brenner and Rector's The Kidney. 9th ed. Elsevier Saunders; 2012.
  90. Thélin CS, Richter JE. Review article: the management of heartburn during pregnancy and lactation. Aliment Pharmacol Ther. 2020;51(4):421‐434. doi:10.1111/apt.15611 [PubMed 31950535]
  91. Topjian AA, Raymond TT, Atkins D, et al. Part 4: pediatric basic and advanced life support: 2020 American Heart Association guidelines for cardiopulmonary resuscitation and emergency cardiovascular care. Circulation. 2020;142(16_suppl_2):S469-S523. doi:10.1161/CIR.0000000000000901 [PubMed 33081526]
  92. Vanden Hoek TL, Morrison LJ, Shuster M, et al. Part 12: Cardiac Arrest in Special Situations: 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation. 2010;122(18)(suppl 3):829-861. doi:10.1161/CIRCULATIONAHA.110.971069 [PubMed 20956228]
  93. Wax PM, Haynes A. Antidotes in depth: physostigmine salicylate. In: Nelson LS, Howland MA, Lewin NA, Smith SW, Goldfrank LR, Hoffman RS, eds. Goldfrank's Toxicologic Emergencies. 11th ed. McGraw-Hill; 2019.
  94. Weisbord SD, Gallagher M, Jneid H, et al; PRESERVE Trial Group. Outcomes after angiography with sodium bicarbonate and acetylcysteine. N Engl J Med. 2018;378(7):603-614. doi:10.1056/NEJMoa1710933 [PubMed 29130810]
  95. Zoungas S, Ninomiya T, Huxley R, et al. Systematic review: sodium bicarbonate treatment regimens for the prevention of contrast-induced nephropathy. Ann Intern Med. 2009;151(9):631-638. doi:10.7326/0003-4819-151-9-200911030-00008 [PubMed 19884624]
Topic 9928 Version 441.0

Do you want to add Medilib to your home screen?