Intravenous sodium bicarbonate

Intravenous sodium bicarbonate, also known as sodium hydrogen carbonate, is a medication primarily used to treat severe metabolic acidosis.[1] For this purpose it is generally only used when the pH is less than 7.1 and when the underlying cause is either diarrhea, vomiting, or the kidneys.[2] Other uses include high blood potassium, tricyclic antidepressant overdose, and cocaine toxicity as well as a number of other poisonings.[1][3][4] It is given by injection into a vein.[2]

Intravenous sodium bicarbonate
Clinical data
Trade namesmany
Other namessodium hydrogen carbonate, monosodium carbonate
AHFS/Drugs.comMonograph
License data
Pregnancy
category
  • US: C (Risk not ruled out)
    Routes of
    administration    		intravenous
    ATC code
    Legal status
    Legal status
    Pharmacokinetic data
    Bioavailability100% (intravenous)
    Identifiers
    CAS Number
    PubChem CID
    DrugBank
    ChemSpider
    • none
    Chemical and physical data
    FormulaCHNaO3
    Molar mass84.01 g·mol−1
     NY (what is this?)  (verify)

    Side effects may include low blood potassium, high blood sodium, and swelling.[1][4] It is not recommended in people with low blood calcium.[5] Sodium bicarbonate is in the alkalinizing family of medication.[5] It works by increasing blood bicarbonate, which buffers excess hydrogen ion and raises blood pH.[5]

    Commercial production of sodium bicarbonate began between 1791 and 1823.[6] Intravenous medical use began around the 1950s.[4] It is on the World Health Organization's List of Essential Medicines, the safest and most effective medicines needed in a health system.[7] Sodium bicarbonate is available as a generic medication.[5] The wholesale cost in the developing world is about US$0.09–2.58 per 10 ml of 8.4% solution.[8] In the United Kingdom this amount costs the NHS about 11.10 pounds.[2]

    Medical uses

    Intravenous sodium bicarbonate is indicated in the treatment of metabolic acidosis, such as can occur in severe kidney disease, diabetic ketoacidosis, circulatory insufficiency, extracorporeal circulation of blood, in hemolysis requiring alkalinization of the urine to avoid nephrotoxicity of blood pigments, and certain drug intoxications, such as by barbiturate overdose, salicylate poisoning, tricyclic antidepressant overdose or methanol poisoning.[9] In addition, sodium bicarbonate is indicated in severe diarrhea, where large amounts of bicarbonate may be lost.[9] However, overall treatment should also strive to treat the underlying cause of the acidosis, such as giving insulin in case of diabetic ketoacidosis.[9]

    Dhaka fluid
    Dhaka fluid[10]
    Concentration in millimoles per litre
    Sodium Chloride85 mM
    Potassium Chloride13 mM
    Sodium bicarbonate48 mM
    Solvent1 Litre of water or 5 percent glucose solution.

    Dhaka fluid is one of the IV fluids used in intravenous rehydration therapy which has sodium bicarbonate content in it.[10] Used as a resuscitative fluid in burn management.[11]

    Contraindications

    Intravenous sodium bicarbonate is contraindicated in patients who are losing chloride, such as by vomiting.[9]

    Because of its sodium content, intravenous sodium bicarbonate should be used with great care, if at all, in patients with congestive heart failure and severe chronic kidney disease, where low sodium intake is strongly indicated to prevent sodium retention.[9] By similar rationale, intravenous sodium bicarbonate should be given with caution to patients receiving corticosteroids.[9]

    Side effects

    Extravasation of intravenous sodium bicarbonate has been reported to cause chemical cellulitis because of its alkalinity, resulting in tissue necrosis, ulceration and/or sloughing at the site of infiltration. This condition is managed by prompt elevation of the part, warmth and local injection of lidocaine or hyaluronidase.[9]

    Interactions

    Norepinephrine and dobutamine cannot be used as additives in an intravenous sodium bicarbonate solution.[9]

    Intravenous sodium bicarbonate should not be mixed with calcium, as they may precipitate, except where compatibility has been previously established for the preparations at hand.[9]

    Overdosing

    Overdose of intravenous sodium bicarbonate results in solute and/or fluid overload, potentially leading to edema, including pulmonary edema.[9] Also, it can cause metabolic alkalosis (with signs including muscular twitchings, irritability and tetany).[9] Hypernatremia is also possible.[9] Repeated fractional doses and frequent monitoring by laboratory tests are recommended to minimize the possibility of overdosing.[9]

    Rapid administration (equal to or exceeding 10 mL/min) of intravenous sodium bicarbonate into neonates and children under two years of age may produce hypernatremia, resulting in a decrease in cerebrospinal fluid pressure and, possibly, intracranial hemorrhage. Therefore, the rate of administration to such patients should not exceed 8 mEq/kg/day, unless a very strong indication is present.[9]

    Composition

    It is administered as a hypertonic solution of sodium bicarbonate, most commonly in concentrations of 4.2%, 5.0%, 7.5% or 8.4%.[9]

    The solutions generally contain no antimicrobial agent or other added buffer.[9]

    Mechanism of action

    After injection, intravenous sodium bicarbonate dissociates to provide sodium (Na+) and bicarbonate (HCO3−) anions. Bicarbonate anions can consume hydrogen ions (H+) and thereby be converted to carbonic acid (H2CO3), which can subsequently be converted to water (H2O) and carbon dioxide (CO2) which can be excreted by the lungs.[9]

    Society and culture

    The Italian physician Tullio Simoncini has claimed that intravenous sodium bicarbonate is an effective cancer therapy. This is rejected by mainstream medicine.[12] Simoncini has been imprisoned twice for culpable manslaughter of people affected by cancer.[13][14]

    References
    1. WHO Model Formulary 2008 (PDF). World Health Organization. 2009. pp. 489–492. ISBN 9789241547659. Archived (PDF) from the original on 13 December 2016. Retrieved 8 January 2017.
    2. British national formulary : BNF 69 (69 ed.). British Medical Association. 2015. p. 684. ISBN 9780857111562.
    3. Bruccoleri, RE; Burns, MM (March 2016). "A Literature Review of the Use of Sodium Bicarbonate for the Treatment of QRS Widening". Journal of Medical Toxicology. 12 (1): 121–9. doi:10.1007/s13181-015-0483-y. PMC 4781799. PMID 26159649.
    4. Dart, Richard C. (2014). Medical Toxicology. Lippincott Williams & Wilkins. p. 257. ISBN 9780781728454. Archived from the original on 16 January 2017.
    5. "Sodium Bicarbonate". The American Society of Health-System Pharmacists. Archived from the original on 18 January 2017. Retrieved 8 January 2017.
    6. Ihde, Aaron J. (1970). The Development of Modern Chemistry. 447: Courier Corporation. ISBN 9780486642352. Archived from the original on 16 January 2017.
    7. World Health Organization (2019). "World Health Organization model list of essential medicines: 21st list 2019". World Health Organization (WHO). hdl:10665/325771. Cite journal requires |journal= (help)
    8. "Sodium Bicarbonate". International Drug Price Indicator Guide. Retrieved 8 December 2016.
    9. Sodium Bicarbonate, Dosage Form: injection, solution Archived 2011-03-03 at the Wayback Machine from Drugs.com. Revised: 03/2011 by General Injectables & Vaccines, Inc.
    10. Tripathi, K.D. (2015). Essentials of Medical Pharmacology (Seventh ed.). New Delhi: Jaypee Brothers Medical Publishers (P) Ltd. p. 679. ISBN 978-93-5025-937-5.
    11. Shahidul, Bari Md. (December 2003). "Fluid Resuscitation of Burn Patients in Bangladesh - "Dhaka Fluid Therapy", An Alternative Approach". Annals of Burns and Fire Disaster. 26: 173–181.
    12. "Sodium Bicarbonate". American Cancer Society. Archived from the original on 3 February 2014. Retrieved 20 March 2014.
    13. Lavinia, Gianvito (21 May 2006). "Medico condannato: omicidio colposo" [Doctor convicted: manslaughter]. Corriere della Sera (in Italian). Milan.
    14. "Doc gets 5 yrs for treating cancer". ANSA.it. 15 January 2018.
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