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Sodium bicarbonate

Indication and Dose

Oral

Urine alkalinisation

Adult: To prevent development of uric-acid renal calculi in the initial stages of uricosuric therapy for hyperuricaemia in chronic gout: Up to 10 g daily in divided doses, to be taken with a liberal amount of fluid. Elderly: Dosage adjustments may be required.

Hepatic impairment: Dosage adjustments may be required. Oral

Chronic metabolic acidosis

Adult: Doses providing 57 mmol (4.8 g sodium bicarbonate) or more daily as required. Elderly: Dosage adjustments may be required.

Hepatic impairment: Dosage adjustments may be required. Oral

Dyspepsia

Adult: 1-5 g in water, may be taken as required. Elderly: Dosage adjustments may be required.

Hepatic impairment: Dosage adjustments may be required. 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.

Hepatic impairment: Dosage adjustments may be required. Administration

Empty Stomach (At least one hour before food or two hours after food) Contraindications

Metabolic or respiratory alkalosis; hypernatraemia, severe pulmonary oedema; hypocalcaemia, hypochlorhydria. Special Precautions

Epilepsy, CHF, renal impairment, liver cirrhosis, hypertension, oedema, eclampsia, aldosteronism. Monitor serum electrolyte concentrations and acid-base status regularly during treatment of acidosis. Pregnancy; lactation. Adverse Drug Reactions

Metabolic alkalosis; mood changes, tiredness, shortness of breath, muscle weakness, irregular heartbeat; muscle hypertonicity, twitching, tetany; hypernatraemia, hyperosmolality, hypocalcaemia, hypokalaemia; stomach cramps, flatulence. Tissue necrosis at inj site. Drug Interaction

Increases toxicity of amphetamines, ephedrine, pseudoephedrine, flecainide, quinidine and quinine.

Decreases effects of lithium, chlorpropamide and salicylates due to increased clearance. May affect the absorption of certain drugs due to raised intra-gastric pH. Pregnancy Category (US FDA)

Category C Mechanism of Action

Sodium bicarbonate raises blood and urinary pH by dissociation to provide bicarbonate ions, which neutralises the hydrogen ion concentration. It also neutralises gastric acid via production of carbon dioxide.

Onset: Oral: Rapid; IV: 15 minutes. Duration: Oral: 8-10 minutes; IV: 1-2 hr.

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