Introduction

  • Sodium bicarbonate is commonly referred as baking soda or bicarbonate 
  • It is made up of two ions namely a cation Na+ and an anion HCO3-
  • Sodium bicarbonate belongs to class of drugs known as antacids 
  • The main consideration in renal patients is due to its balancing properties such as making the blood or urine more alkaline or increased pH
  • Moreover,it buffers the excess H+ion concentration in blood or urine 

Uses

  • It can be also indicated in multiple conditions such as Acute metabolic acidosis (pH-<7.1-7.2 with acute kidney injury)
  •  lactic acidosis(pH<7.0),Chronic metabolic acidosis (pH-50-100mEq orally) 
  • Severe hyperkalemia>6mEq/l or >5.5mEq/l with arrhythmias or cardiovascular instability or conduction related disease 
  • Cardiac arrest , Diabetic ketoacidosis
  • Other than the above mentioned diseases it is also used in metabolic acidosis related conditions such as Severe renal diseases, Uncontrolled diabetes,Cardiac arrest etc 

How does it work ?

  • As mentioned before both the anion and cation in the sodium bicarbonate dissociates to form sodium and bicarbonate ions 
  • Further it consumes hydrogen ions to convert it in to H2CO3 which is known as carbonic acid 
  • Thereafter the carbonic acid breaks down into water and carbon dioxide
  • These two helps to perform its function by buffering the hydrogen ion concentration resulting in elevation of pH levels 
  • The sodium bicarbonate values or intake or elimination is regulated by the kidneys.

Dosages 

  • It can be advised orally or Intravenous mode of administration
  • Available in the form of powder with 325 mg and tablets of dose 650 mg 
  • Where 1 mEq NaHco3 contains 83 mg
  • 1000mg contains 1 gm of NaHco3 which means contains 11.9mEq of Na+ and HCO3-
  • 650 mg contains 7.7 mEq of Na+ and HCO3-
  • Intravenous mode of administration dosage contains 7.5% concentration is equal to 44.6 mEq NaHco3 in 50ml which also contains 0.7mEq/l for each Na+ and Hco3-
  • 8.4% concentration is equal to 50 mgEq/l for each 1mEq/ml
  • Also available at 5 and 4.2% concentrations

Adverse effects 

  • Nausea, vomiting
  • Headache
  • Muscle pain
  • Taste alterations
  • Bradypnea
  • Increased urinary frequency
  • Necrosis
  • Restlessness
  • Muscle twitches
  • Toxicities
  • At higher dosage administration may lead to chemical cellulitis leading to necrosis and ischemia,tissue death at injected sites
  • Sometimes leading to edema in patients with renal insufficiency and also decreased CSF pressure and intracranial hemorrhage etc 

Contraindications

  •  metabolic alkalosis or respiratory alkalosis
  • Hypocalcemia
  • Drug interactions with antibiotics such as Doxycycline Levofloxacin,minocycline , tetracyclines.
  • sulfasalazine,mesalamine ,NSAIDs or other related drugs classes
  • Hypersensitive patients  
  • Renal disease patients the dosage and administration is highly controlled at required ranges

Frequently asked questions

Is sodium bicarbonate good for Kidney patients?

Treatment with sodium bicarbonate  or sodium citrate pills is good to keep kidney disease from getting worse and enable to keep it healthy by improving nutritional status

Why is sodium bicarbonate given to renal patients?

Sodium bicarbonate supplementation  therapy is administered to slow down  the rate of decline of renal function as assessed by CrCl to 1 ml/min per year
It is also known to significantly reduce the progression to end stage renal disease

At what stages of renal disease is sodium bicarbonate advised?

At stages of chronic kidney diseases III and IV with the administration of sodium bicarbonate can correct metabolic acidosis and it’s related symptoms 

Does sodium bicarbonate reduce creatinine?

Yes,sodium bicarbonate can reduce the rate of creatinine clearance levels 
Studies have shown that the patient with chronic kidney disease of stage IV have positive results with  CrCL decline from 5.93 mL/min to 1.88mL/min per 
1.73m²/year

What is the bicarbonate level to maintain in patients with CKD ?

According to Kidney Dialysis Outcomes Quality Initiative (KDOQI) guidelines ,the bicarbonate levels to maintain in patients with CKD is ≥22mEq/L

Does sodium bicarbonate lower potassium?

Yes ,Sodium bicarbonate lowers plasma potassium, independent and irrespective of its effect on blood pH, and despite a risk of volume overload.
Moreover ,in the presence of renal failure   provided the plasma bicarbonate concentration is decreased than usual
should be used to treat hyperkalemia in compensated acid-base disorders

Can you take sodium bicarbonate everyday?

The  maximum daily dosage of sodium bicarbonate is about 200 mEq sodium and 200 mEq bicarbonate in the age group about 60 years old  
Over 60 years old for 2 weeks recommended Maximum daily dosage is of 100 mEq sodium and 100 mEq bicarbonate 
Higher dosages consumed orally is not recommended and considered harmful 

Does sodium bicarbonate affect blood pressure?

Yes, NaHCO3 or sodium bicarbonate is known to decrease the systolic blood pressure (by 5 mmHg) and renin activity in the hypertensive subjects 

Why is sodium bicarbonate not recommended for individuals with kidney disease?

Due to long-term sodium bicarbonate supplementation in patients with CKD leads to sodium mediated fluid retention, resulting in weight gain, peripheral edema, elevated blood pressure and even heart failure .So this is the main reason why it is not recommended for individuals with kidney disease 

When is sodium bicarbonate contraindicated?

Sodium Bicarbonate Injections contraindicated in patients receiving diuretics are known to produce a hypochloremic alkalosis and also in patients with severe vomiting with chlorine loss is contraindicated

Why is Bicarbonate low in renal failure?

As the kidney loses its function of loses it ability to ammonia synthesis and excrete hydrogen ions 
Also the lesser eGFR levels the lesser is the bicarbonate levels (less than 22 mmol/l)

Why do dialysis patients need Bicarbonates?

Bicarbonate administration via the dialysate helps to maintain the acid-base balance in patients undergoing dialysis
As we know, chronic metabolic acidosis is common in dialysis patients. It is highly needed

How many times can you take sodium bicarbonate?

Advised to take a single tablet, dissolved in a glass of water, as mentioned . Maximum daily dose for adults  60 years of age is 24 tablets.
Maximum daily dose for adults 60 or above 60 years is 12 tablets.

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