indication

Sodium bicarbonate is used for the treatment of metabolic acidosis which may occur in severe renal disease, uncontrolled diabetes, circulatory insufficiency due to shock or severe dehydration, extracorporeal circulation of blood, cardiac arrest and severe primary lactic acidosis. Also is indicated in severe diarrhea which is often accompanied by a significant loss of bicarbonate. Further indicated in the treatment of certain drug intoxications, including barbiturates (where dissociation of the barbiturateprotein complex is desired), in poisoning by salicylates or methyl alcohol and in hemolytic reactions requiring alkalinization of the urine to diminish nephrotoxicity of blood pigments.

pharmacology

Intravenous sodium bicarbonate therapy increases plasma bicarbonate, buffers excess hydrogen ion concentration, raises blood pH and reverses the clinical manifestations of acidosis.

mechanism of action

Sodium bicarbonate is a systemic alkalizer, which increases plasma bicarbonate, buffers excess hydrogen ion concentration, and raises blood pH, thereby reversing the clinical manifestations of acidosis. It is also a urinary alkalizer, increasing the excretion of free bicarbonate ions in the urine, thus effectively raising the urinary pH. By maintaining an alkaline urine, the actual dissolution of uric acid stones may be accomplished. Sodium bicarbonate acts as an antacid and reacts chemically to neutralize or buffer existing quantities of stomach acid but has no direct effect on its output. This action results in increased pH value of stomach contents, thus providing relief of hyperacidity symptoms. [PharmGKB]

drug interactions

Atazanavir: This gastric pH modifier decreases the levels/effect of atazanavir

Benzphetamine: Alkalinizing agents such as sodium bicarbonate may decrease the excretion of amphetamines like benzphetamine. Increased clinical effects and/or toxicity may occur. Therapy modification should be considered.

Lithium: The urine alkalizer decreases the effect of lithium

Memantine: Possible increased levels of memantine

Quinidine: The antacid increases the effect of quinidine

Ticlopidine: Sodium bicarbonate may decrease Ticlopidine levels. Administer agents 1 to 2 hours apart.

Tipranavir: Sodium bicarbonate may decrease the absorption of Tipranavir. Separate administration of the agents and monitor for decreased efficacy of Tipranavir.

Trandolapril: Sodium bicarbonate may decrease the absorption of Trandolapril. Administration should be spaced.