Sodium Bicarbonate is indicated for:

1. Management of acidosis during cardiac arrest
2. Alkalinization of urine
3. Management of metabolic acidosis in conditions such as:

• Severe renal disease
• Uncontrolled diabetes mellitus
• Circulatory failure due to shock or dehydration
• Severe primary lactic acidosis

Sodium Bicarbonate is a systemic alkalizing agent that increases plasma bicarbonate levels, buffers excess hydrogen ions, and raises blood pH. This helps reverse the clinical effects of acidosis. It also acts as a urinary alkalizer by increasing bicarbonate excretion in urine, thereby raising urinary pH. In addition, it helps correct electrolyte imbalance in severe diarrhea, where significant bicarbonate loss may occur.

Oral: The usual dose is 300 mg to 2 grams, 1 to 4 times daily.

Intravenous (Severe metabolic acidosis):

• Adult: By slow inj of a hypertonic solution of up to 8.4% (1000 mmol/L), or by continuous infusion of a weaker solution, usually 1.26% (150 mmol/L). For correction of acidosis during advanced cardiac life support procedures, 50 ml of an 8.4% solution may be given.
• Elderly: Dosage adjustments may be required.

This medicine may interact with aspirin and other salicylates, memantine, and enteric-coated medications.Potentially significant interactions may occur with corticosteroids, corticotropin, alkalis, calcium, diuretics, and potassium. It may also reduce the effectiveness of drugs such as ampicillin, atazanavir, ketoconazole, itraconazole, iron supplements, and sucralfate.

This drug is contraindicated in hypersensitivity reactions, hypoventilatory states, severe chloride depletion due to prolonged gastric fluid loss (vomiting or GI suction), metabolic or respiratory alkalosis, hypocalcemia, and in patients using diuretics that cause hypochloremic alkalosis.

Common side effects:

• Headache
• Nausea
• Irritability

Serious effects (report to doctor):

• Muscle weakness
• Slow reflexes
• Confusion
• Swelling of feet or ankles
• Black tar-like stools
• Coffee-ground vomiting

Use during pregnancy only if the potential benefit outweighs the risk to the fetus. Animal studies suggest possible adverse renal effects, so use is not recommended during the second and third trimesters. It may also worsen hypertension. This medicine may pass into breast milk.

Use with caution in patients with heart disease, kidney disease, liver disease, hypertension, or allergy history. Because this medicine contains sodium, it should be avoided in patients on a salt-restricted diet.

In case of alkalosis, the medicine should be stopped and treatment given according to severity. 0.9% sodium chloride IV may be used, and potassium chloride may be required if hypokalemia is present. Severe alkalosis may cause irritability or tetany, which can be managed with calcium gluconate. An acidifying agent such as ammonium chloride may also be required in severe cases.

Intravenous fluid preparations, urinary alkalinizing agent

Do not store above 30°C. Protect from light and moisture. Keep out of reach of children.