Intravenous sodium bicarbonate

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Intravenous sodium bicarbonate
SodiumBicarbonate.svg
Clinical data
Trade names many
Other namessodium hydrogen carbonate, monosodium carbonate
AHFS/Drugs.com Monograph
MedlinePlus a682001
License data
Routes of
administration 		intravenous
ATC code
Legal status
Legal status
Pharmacokinetic data
Bioavailability 100% (intravenous)
Identifiers
  • sodium hydrogen carbonate
CAS Number
PubChem CID
DrugBank
ChemSpider
UNII
KEGG
ChEBI
ChEMBL
Chemical and physical data
Formula CHNaO3
Molar mass 84.006 g·mol−1
3D model (JSmol)
  • C(=O)(O)[O-].[Na+]
  • InChI=1S/CH2O3.Na/c2-1(3)4;/h(H2,2,3,4);/q;+1/p-1
  • Key:UIIMBOGNXHQVGW-UHFFFAOYSA-M
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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]

Contents

Side effects may include low blood potassium, high blood sodium, and swelling. [1] [4] It is not recommended for people with low blood calcium level. [5] Sodium bicarbonate is in the alkalinizing family of medications. [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. [7] Sodium bicarbonate is available as a generic medication. [5]

Medical uses

Intravenous sodium bicarbonate is indicated in the treatment of metabolic acidosis, such as can occur in severe kidney disease, diabetic ketoacidosis [ citation needed ], 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. [8] In addition, sodium bicarbonate is indicated in severe diarrhea, where large amounts of bicarbonate may be lost. [8] However, overall treatment should also strive to treat the underlying cause of the acidosis, such as giving insulin in case of diabetic ketoacidosis. [8]

Dhaka fluid

Dhaka fluid [9]
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. [9] Used as a resuscitative fluid in burn management. [10]

Contraindications

Intravenous sodium bicarbonate is contraindicated in patients who are losing chloride, such as by vomiting. [8]

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. [8] By similar rationale, intravenous sodium bicarbonate should be given with caution to patients receiving corticosteroids. [8]

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. [8]

Interactions

Norepinephrine and dobutamine cannot be used as additives in an intravenous sodium bicarbonate solution. [8]

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. [8]

Overdosing

Overdose of intravenous sodium bicarbonate results in solute and/or fluid overload, potentially leading to edema, including pulmonary edema. [8] Also, it can cause metabolic alkalosis (with signs including muscular twitchings, irritability and tetany). [8] Hypernatremia is also possible. [8] Repeated fractional doses and frequent monitoring by laboratory tests are recommended to minimize the possibility of overdosing. [8]

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. [8]

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%. [8]

The solutions generally contain no antimicrobial agent or other added buffer. [8]

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. [8]

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. [11] Simoncini has been imprisoned twice for culpable manslaughter of people affected by cancer. [12] [13]

Related Research Articles

<span class="mw-page-title-main">Diabetic ketoacidosis</span> Medical condition

Diabetic ketoacidosis (DKA) is a potentially life-threatening complication of diabetes mellitus. Signs and symptoms may include vomiting, abdominal pain, deep gasping breathing, increased urination, weakness, confusion and occasionally loss of consciousness. A person's breath may develop a specific "fruity" smell. The onset of symptoms is usually rapid. People without a previous diagnosis of diabetes may develop DKA as the first obvious symptom.

<span class="mw-page-title-main">Pentamidine</span> Medical antimicrobial drug

Pentamidine is an antimicrobial medication used to treat African trypanosomiasis, leishmaniasis, Balamuthia infections, babesiosis, and to prevent and treat pneumocystis pneumonia (PCP) in people with poor immune function. In African trypanosomiasis it is used for early disease before central nervous system involvement, as a second line option to suramin. It is an option for both visceral leishmaniasis and cutaneous leishmaniasis. Pentamidine can be given by injection into a vein or muscle or by inhalation.

Diuresis is the excretion of urine, especially when excessive (polyuria). The term collectively denotes the physiologic processes underpinning increased urine production by the kidneys during maintenance of fluid balance.

<span class="mw-page-title-main">Acetazolamide</span> Chemical compound

Acetazolamide, sold under the trade name Diamox among others, is a medication used to treat glaucoma, epilepsy, acute mountain sickness, periodic paralysis, idiopathic intracranial hypertension, heart failure and to alkalinize urine. It may be used long term for the treatment of open angle glaucoma and short term for acute angle closure glaucoma until surgery can be carried out. It is taken by mouth or injection into a vein. Acetazolamide is a first generation carbonic anhydrase inhibitor and it decreases the ocular fluid and osmolality in the eye to decrease intraocular pressure.

Acidosis is a biological process producing hydrogen ions and increasing their concentration in blood or body fluids. pH is the negative log of hydrogen ion concentration and so it is decreased by a process of acidosis.

<span class="mw-page-title-main">Hyperkalemia</span> Excess potassium in the blood

Hyperkalemia is an elevated level of potassium (K+) in the blood. Normal potassium levels are between 3.5 and 5.0 mmol/L (3.5 and 5.0 mEq/L) with levels above 5.5 mmol/L defined as hyperkalemia. Typically hyperkalemia does not cause symptoms. Occasionally when severe it can cause palpitations, muscle pain, muscle weakness, or numbness. Hyperkalemia can cause an abnormal heart rhythm which can result in cardiac arrest and death.

<span class="mw-page-title-main">Electrolyte imbalance</span> Abnormality in the concentration of electrolytes in the body

Electrolyte imbalance, or water-electrolyte imbalance, is an abnormality in the concentration of electrolytes in the body. Electrolytes play a vital role in maintaining homeostasis in the body. They help to regulate heart and neurological function, fluid balance, oxygen delivery, acid–base balance and much more. Electrolyte imbalances can develop by consuming too little or too much electrolyte as well as excreting too little or too much electrolyte. Examples of electrolytes include calcium, chloride, magnesium, phosphate, potassium, and sodium.

Hypernatremia, also spelled hypernatraemia, is a high concentration of sodium in the blood. Early symptoms may include a strong feeling of thirst, weakness, nausea, and loss of appetite. Severe symptoms include confusion, muscle twitching, and bleeding in or around the brain. Normal serum sodium levels are 135–145 mmol/L. Hypernatremia is generally defined as a serum sodium level of more than 145 mmol/L. Severe symptoms typically only occur when levels are above 160 mmol/L.

Hyperchloremia is an electrolyte disturbance in which there is an elevated level of chloride ions in the blood. The normal serum range for chloride is 96 to 106 mEq/L, therefore chloride levels at or above 110 mEq/L usually indicate kidney dysfunction as it is a regulator of chloride concentration. As of now there are no specific symptoms of hyperchloremia; however, it can be influenced by multiple abnormalities that cause a loss of electrolyte-free fluid, loss of hypotonic fluid, or increased administration of sodium chloride. These abnormalities are caused by diarrhea, vomiting, increased sodium chloride intake, renal dysfunction, diuretic use, and diabetes. Hyperchloremia should not be mistaken for hyperchloremic metabolic acidosis as hyperchloremic metabolic acidosis is characterized by two major changes: a decrease in blood pH and bicarbonate levels, as well as an increase in blood chloride levels. Instead those with hyperchloremic metabolic acidosis are usually predisposed to hyperchloremia.

<span class="mw-page-title-main">Metabolic acidosis</span> Imbalance in the bodys acid-base equilibrium

Metabolic acidosis is a serious electrolyte disorder characterized by an imbalance in the body's acid-base balance. Metabolic acidosis has three main root causes: increased acid production, loss of bicarbonate, and a reduced ability of the kidneys to excrete excess acids. Metabolic acidosis can lead to acidemia, which is defined as arterial blood pH that is lower than 7.35. Acidemia and acidosis are not mutually exclusive – pH and hydrogen ion concentrations also depend on the coexistence of other acid-base disorders; therefore, pH levels in people with metabolic acidosis can range from low to high.

<span class="mw-page-title-main">Saline (medicine)</span> Saline water for medical purposes

Saline is a mixture of sodium chloride (salt) and water. It has a number of uses in medicine including cleaning wounds, removal and storage of contact lenses, and help with dry eyes. By injection into a vein, it is used to treat hypovolemia such as that from gastroenteritis and diabetic ketoacidosis. Large amounts may result in fluid overload, swelling, acidosis, and high blood sodium. In those with long-standing low blood sodium, excessive use may result in osmotic demyelination syndrome.

<span class="mw-page-title-main">Ringer's lactate solution</span> Fluid used for resuscitation after blood loss

Ringer's lactate solution (RL), also known as sodium lactate solution,Lactated Ringer's (LR), and Hartmann's solution, is a mixture of sodium chloride, sodium lactate, potassium chloride, and calcium chloride in water. It is used for replacing fluids and electrolytes in those who have low blood volume or low blood pressure. It may also be used to treat metabolic acidosis and to wash the eye following a chemical burn. It is given by intravenous infusion or applied to the affected area.

<span class="mw-page-title-main">Metabolic alkalosis</span> Abnormally high tissue pH due to metabolic dysfunction

Metabolic alkalosis is an acid-base disorder in which the pH of tissue is elevated beyond the normal range (7.35–7.45). This is the result of decreased hydrogen ion concentration, leading to increased bicarbonate, or alternatively a direct result of increased bicarbonate concentrations. The condition typically cannot last long if the kidneys are functioning properly.

A basic metabolic panel (BMP) is a blood test consisting of a set of seven or eight biochemical tests and is one of the most common lab tests ordered by health care providers. Outside the United States, blood tests made up of the majority of the same biochemical tests are called urea and electrolytes, or urea, electrolytes, creatinine, and are often referred to as 'kidney function tests' as they also include a calculated estimated glomerular filtration rate. The BMP provides key information regarding fluid and electrolyte status, kidney function, blood sugar levels, and response to various medications and other medical therapies. It is frequently employed as a screening tool during a physical exam.

<span class="mw-page-title-main">High anion gap metabolic acidosis</span> Medical condition

High anion gap metabolic acidosis is a form of metabolic acidosis characterized by a high anion gap. Metabolic acidosis occurs when the body produces too much acid, or when the kidneys are not removing enough acid from the body. Several types of metabolic acidosis occur, grouped by their influence on the anion gap.

<span class="mw-page-title-main">Tricyclic antidepressant overdose</span> Medical condition

Tricyclic antidepressant overdose is poisoning caused by excessive medication of the tricyclic antidepressant (TCA) type. Symptoms may include elevated body temperature, blurred vision, dilated pupils, sleepiness, confusion, seizures, rapid heart rate, and cardiac arrest. If symptoms have not occurred within six hours of exposure they are unlikely to occur.

<span class="mw-page-title-main">Salicylate poisoning</span> Medical condition

Salicylate poisoning, also known as aspirin poisoning, is the acute or chronic poisoning with a salicylate such as aspirin. The classic symptoms are ringing in the ears, nausea, abdominal pain, and a fast breathing rate. Early on, these may be subtle, while larger doses may result in fever. Complications can include swelling of the brain or lungs, seizures, low blood sugar, or cardiac arrest.

The Hs and Ts is a mnemonic used to aid in remembering the possible reversible causes of cardiac arrest. A variety of disease processes can lead to a cardiac arrest; however, they usually boil down to one or more of the "Hs and Ts".

<span class="mw-page-title-main">Intravenous sugar solution</span> Dextrose solution used to treat low blood sugar

Intravenous sugar solution, also known as dextrose solution, is a mixture of dextrose (glucose) and water. It is used to treat low blood sugar or water loss without electrolyte loss. Water loss without electrolyte loss may occur in fever, hyperthyroidism, high blood calcium, or diabetes insipidus. It is also used in the treatment of high blood potassium, diabetic ketoacidosis, and as part of parenteral nutrition. It is given by injection into a vein.

<span class="mw-page-title-main">Sodium thiosulfate (medical use)</span> Pharmaceutical compound

Sodium thiosulfate, also spelled sodium thiosulphate, is used as a medication to treat cyanide poisoning, pityriasis versicolor, and to decrease side effects from cisplatin. For cyanide poisoning, it is often used after the medication sodium nitrite and is typically only recommended for severe cases. It is either given by injection into a vein or applied to the skin.

References

  1. 1 2 3 World Health Organization (2009). Stuart MC, Kouimtzi M, Hill SR (eds.). WHO Model Formulary 2008. World Health Organization. pp. 489–492. hdl:10665/44053. ISBN   9789241547659.
  2. 1 2 British National Formulary: BNF 69 (69th 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): 121–129. doi:10.1007/s13181-015-0483-y. PMC   4781799 . PMID   26159649.
  4. 1 2 3 Liebelt EL (2014). "Sodium Bicarbonate". In Dart RC (ed.). Medical Toxicology. Lippincott Williams & Wilkins. p. 257. ISBN   9780781728454. Archived from the original on 16 January 2017.
  5. 1 2 3 4 "Sodium Bicarbonate". The American Society of Health-System Pharmacists. Archived from the original on 18 January 2017. Retrieved 8 January 2017.
  6. ↑ Ihde AJ (1970). "Chemical Industry I: The Nineteenth Century". The Development of Modern Chemistry. Courier Corporation. p. 447. 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. Geneva: World Health Organization. hdl: 10665/325771 . WHO/MVP/EMP/IAU/2019.06. License: CC BY-NC-SA 3.0 IGO.
  8. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 "Sodium Bicarbonate, Dosage Form: injection, solution by General Injectables & Vaccines, Inc". Drugs.com . March 2011. Archived from the original on 3 March 2011.
  9. 1 2 Tripathi KD (2015). Essentials of Medical Pharmacology (Seventh ed.). New Delhi: Jaypee Brothers Medical Publishers (P) Ltd. p. 679. ISBN   978-93-5025-937-5.
  10. ↑ Shahidul BM (December 2003). "Fluid Resuscitation of Burn Patients in Bangladesh - "Dhaka Fluid Therapy", An Alternative Approach". Annals of Burns and Fire Disaster. 26: 173–181. S2CID   2902069.
  11. ↑ "Sodium Bicarbonate". American Cancer Society . Archived from the original on 3 February 2014. Retrieved 20 March 2014.
  12. ↑ Lavinia G (21 May 2006). "Medico condannato: omicidio colposo" [Doctor convicted: manslaughter]. Corriere della Sera (in Italian). Milan.
  13. ↑ "Doc gets 5 yrs for treating cancer". ANSA.it. 15 January 2018.
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