Treatment of metabolic acidosis, hyperkalemia, drug intoxication (barbiturates), and severe diarrhea

Alkalinizing Agent; Antacid; Electrolyte Supplement

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%)

Alkalosis, hypernatremia, severe pulmonary edema, hypocalcemia, unknown abdominal pain
Neutralizing additive (dental use): Not for use as a systemic alkalizer

C(FDA)

WHO: Compatible with breastfeeding.
Micromedex: Infant risk is minimal.

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

Each oral tablet (600 mg) contains ~7.2 mEq each of Na+ and HCO3-.
Metabolic acidosis in patients with CKD: Oral (off-label):
Note: KDIGO guidelines suggest oral replacement when plasma [HCO3-] <22 mEq/L.
Initial: 15.4 to 23.1 mEq/day in divided doses (eg, 650 mg tablet 2 -3 times daily);
titrate to normal serum [HCO3-] (eg, 23 to 29 mEq/L) or up to 5850 mg/day.
Avoid exceeding serum [HCO3-] >32 mEq/L since this has been associated with increased mortality in patients with CKD.
Antacid: Oral: 325 mg - 2 g QD-QID
Urine alkalinization: Oral: Initial: 48 mEq (4 g), then 12 -24 mEq (1-2 g) Q4H;
dose should be titrated to desired urinary pH; doses up to 16 g/day (200 mEq) in patients <60 years and 8 g (100 mEq) in patients >60 years.

Chronic renal failure: Oral:
Children: Initiate when plasma HCO3- <15 mEq/L: 1-3 mEq/kg/day
Renal tubular acidosis, distal: Oral:
Children: 2-3 mEq/kg/day
Renal tubular acidosis, proximal:
Children: Initial: 5-10 mEq/kg/day; maintenance: Increase as required to maintain serum bicarbonate in the normal range
Urine alkalinization: Oral:
Children: 1-10 mEq (84-840 mg)/kg/day in divided doses every 4-6 hours; dose should be titrated to desired urinary pH.

Routine use of NaHCO3 is not recommended.

Routine use of NaHCO3 is not recommended.

store below 25°C. Protect from moisture and light.