Pill Identifier App

Sodium Bicarbonate (Systemic)


VA CLASSIFICATION
Primary: GA110
Secondary: TN409

Commonly used brand name(s): Arm and Hammer Pure Baking Soda; Bell/ans; Citrocarbonate; Soda Mint.

Note: For a listing of dosage forms and brand names by country availability, see Dosage Forms section(s).



Category:


Alkalizer (systemic; urinary)—Sodium Bicarbonate Injection USP; Sodium Bicarbonate Oral Powder USP; Sodium Bicarbonate Tablets USP;

Antacid—Effervescent Sodium Bicarbonate; Sodium Bicarbonate Oral Powder USP; Sodium Bicarbonate Tablets USP;

Electrolyte replenisher—Sodium Bicarbonate Injection USP;

Indications

Note: Bracketed information in the Indications section refers to uses that are not included in U.S. product labeling.

Accepted

Metabolic acidosis (treatment)—
Acute mild to moderate{01}
In renal tubular disorders{04}
In severe renal disease (renal tubular acidosis)
In circulatory insufficiency, due to shock or severe dehydration{01}
In cardiac arrest{01}
In extracorporeal circulation of blood{01} and
In primary lactic acidosis, severe{01}—Oral sodium bicarbonate is indicated in the treatment of metabolic acidosis. It is preferred over parenteral therapy in acute mild to moderate acidosis. Oral sodium bicarbonate is also indicated to correct acidosis in renal tubular disorders. Parenteral sodium bicarbonate is indicated to minimize risks of metabolic acidosis in severe renal disease, circulatory insufficiency due to shock or severe dehydration, extracorporeal circulation of blood, cardiac arrest, and severe primary lactic acidosis.
—Intravenous sodium bicarbonate has been used to minimize the risks of metabolic acidosis in uncontrolled diabetes {01}; however, it generally has been replaced by low-dose insulin therapy and saline, potassium, and fluid replacement. With low-dose insulin therapy there is less risk of developing serious hypoglycemia and/or hypokalemia.

Renal calculi, uric acid (prophylaxis)—Oral sodium bicarbonate is indicated to reduce uric acid crystallization as an adjuvant to uricosuric medication in gout. {14}

Hyperacidity (treatment)—Also indicated orally to provide symptomatic relief of upset stomach associated with hyperacidity. It may also be used in the treatment of the symptoms of peptic ulcer disease. {02}

Diarrhea (treatment adjunct)—Parenteral sodium bicarbonate is indicated in severe diarrhea in which the loss of bicarbonate is significant. {01}

Toxicity, nonspecific (treatment)—Parenteral sodium bicarbonate is indicated in the treatment of certain drug intoxications, including barbiturates, and in poisoning by salicylates or methyl alcohol. {01}
—Sodium bicarbonate is not recommended for use as an antidote following the ingestion of strong mineral acids, since the formation of carbon dioxide may distend the weakened stomach and lead to gastric rupture.

—Sodium bicarbonate has been used as a urinary alkalizer to increase sulfonamide solubility and prevent crystallization that may lead to renal calculi or nephrotoxicity; however, poorly soluble sulfonamides are rarely used now. {14} {19} {20} {21}

—[Sodium bicarbonate has been used in the treatment of sickle cell anemia; however, it generally has been replaced by more effective agents.] {22}


Pharmacology/Pharmacokinetics

Physicochemical characteristics:
Molecular weight—
    84.01

Mechanism of action/Effect:

Alkalizer, systemic—Increases the plasma bicarbonate, buffers excess hydrogen ion concentration, and raises blood pH, thereby reversing the clinical manifestations of acidosis. {01}

Alkalizer, urinary—Increases 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.

Antacid—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. {01}

Elimination:
    Renal; CO 2 formed is eliminated via lungs. {01}


Precautions to Consider

Pregnancy/Reproduction

Pregnancy—
Problems in humans have not been documented; however, risk-benefit must be considered, since sodium bicarbonate is absorbed systemically. Chronic use may lead to systemic alkalosis. The sodium load that is absorbed can also cause edema and weight gain.

For parenteral dosage form: Studies have not been done in humans. {01}

Studies have not been done in animals.

FDA Pregnancy Category C. {01}

Breast-feeding

It is not known whether sodium bicarbonate is distributed into breast milk. However, problems in humans have not been documented. {01}

Pediatrics

Antacids should not be given to young children (up to 6 years of age) unless prescribed by a physician. Since children are not usually able to describe their symptoms precisely, proper diagnosis should precede the use of an antacid. This will avoid the complication of an existing condition (e.g., appendicitis) or the appearance of more severe adverse effects.


Geriatrics


No information is available on the relationship of age to the effects of sodum bicarbonate in geriatric patients. However, elderly patients are more likely to have age-related renal function impairment, which may require caution in patients receiving sodium bicarbonate. {01}

Drug interactions and/or related problems
The following drug interactions and/or related problems have been selected on the basis of their potential clinical significance (possible mechanism in parentheses where appropriate)—not necessarily inclusive (» = major clinical significance):


Note: Not all interactions between sodium bicarbonate and other oral medications have been identified in this monograph. Because concurrent use may increase or reduce the rate and/or extent of absorption of other oral medications, patients should be advised not to take any other oral medications within 1 to 2 hours of sodium bicarbonate.
Combinations containing any of the following medications, depending on the amount present, may also interact with this medication.

Acidifiers, urinary, such as:
Ammonium chloride
Ascorbic acid
Potassium or sodium phosphates    (antacids may alkalinize the urine and counteract the effect of urinary acidifiers; frequent use of antacids, especially in high doses, is best avoided by patients receiving therapy to acidify the urine)


Amphetamines or{07}
Quinidine{06}{07}    (urinary excretion may be inhibited when these medications are used concurrently with sodium bicarbonate, possibly resulting in toxicity; dosage adjustment may be needed when sodium bicarbonate therapy is initiated or discontinued or if dosage is changed {23})


Anticholinergics or other medications with anticholinergic action (See Appendix II )    (concurrent use with sodium bicarbonate may decrease absorption, reducing the effectiveness of the anticholinergic; doses of these medications should be spaced 1 hour apart from doses of sodium bicarbonate; also, urinary excretion may be delayed by alkalinization of the urine, thus potentiating the side effects of the anticholinergic {23} {24})


Calcium-containing preparations or
Milk or milk products    (concurrent and prolonged use with sodium bicarbonate may result in the milk-alkali syndrome {01} {25})


Ciprofloxacin or{15}
Norfloxacin or{26}
Ofloxacin    (alkalinization of the urine may reduce the solubility of ciprofloxacin, norfloxacin, or ofloxacin in the urine; patients should be observed for signs of crystalluria and nephrotoxicity)


Citrates    (concurrent use with antacids containing sodium bicarbonate may result in systemic alkalosis)

    (concurrent use with sodium bicarbonate may promote the development of calcium stones in patients with uric acid stones, due to sodium ion opposition to the hypocalciuric effect of the alkaline load; may also cause hypernatremia {32})


Enteric-coated medications, such as bisacodyl    (concurrent administration of antacids with enteric-coated tablets may cause the enteric coating to dissolve too rapidly, resulting in gastric or duodenal irritation {27})


Ephedrine    (urine alkalinization induced by sodium bicarbonate may increase the half-life of ephedrine and prolong its duration of action, especially if the urine remains alkaline for several days or longer; dosage adjustment of ephedrine may be necessary {07} {37})


Histamine H 2-receptor antagonists, such as
Cimetidine
Famotidine
Nizatidine
Ranitidine    (concurrent use with sodium bicarbonate may be indicated in the treatment of peptic ulcer to relieve pain; however, simultaneous administration of antacids of medium to high potency [80 mmol to 150 mmol HCl] is not recommended since absorption of these medications may be decreased; patients should be advised not to take any antacids within one-half to 1 hour of histamine H 2-receptor antagonists {16} {17} {28} {29})


Iron supplements or preparations, oral    (absorption may be decreased when these preparations are used concurrently with antacids containing carbonate; because of the formation of less soluble complexes, iron supplements should not be taken within 1 hour before or 2 hours after sodium bicarbonate {06} {07})


» Ketoconazole    (sodium bicarbonate may cause increased gastrointestinal pH; concurrent administration with sodium bicarbonate may result in a marked reduction in absorption of ketoconazole; patients should take sodium bicarbonate at least 2 hours after ketoconazole {08})


Lithium    (sodium bicarbonate enhances lithium excretion, possibly resulting in decreased efficacy; this may be partly due to the sodium content {07} {33} {34} {35})


» Mecamylamine    (alkalinization of the urine caused by sodium bicarbonate slows excretion and prolongs the effects of mecamylamine; concurrent use is not recommended {07} {31})


» Methenamine    (alkalinization of the urine caused by sodium bicarbonate may reduce the effectiveness of methenamine by inhibiting its conversion to formaldehyde; concurrent use is not recommended {06} {07})


Mexiletine    (marked alkalinization of the urine caused by sodium bicarbonate may retard renal excretion of mexiletine {07})


Potassium supplements    (concurrent use of sodium bicarbonate infusion decreases serum potassium concentration by promoting a shift of potassium ion into the cells {35})


Salicylates    (alkalinization of the urine may increase renal salicylate excretion and lower serum salicylate concentrations; dosage adjustments of salicylates may be necessary when chronic high-dose antacid therapy with sodium bicarbonate is started or stopped, especially in patients receiving large doses of the salicylate, such as those with rheumatoid arthritis and rheumatic fever {07} {09} {23})


Sucralfate    (concurrent use with sodium bicarbonate may be indicated in the treatment of duodenal ulcer to relieve pain; however, simultaneous administration is not recommended since antacids, such as sodium bicarbonate, may interfere with binding of sucralfate to the mucosa; patients should be advised not to take sodium bicarbonate within one-half hour before or 1 hour after sucralfate {18})


» Tetracyclines, oral    (absorption may be decreased when oral tetracyclines are used concurrently with sodium bicarbonate because of increase in intragastric pH; patients should be advised not to take sodium bicarbonate within 1 to 2 hours of tetracyclines {06} {07})



Laboratory value alterations
The following have been selected on the basis of their potential clinical significance (possible effect in parentheses where appropriate)—not necessarily inclusive (» = major clinical significance):

With diagnostic test results
» Gastric acid secretion test    (concurrent use of sodium bicarbonate may antagonize the effect of pentagastrin or histamine in the evaluation of gastric acid secretory function; administration of sodium bicarbonate is not recommended on the morning of the test)

With physiology/laboratory test values
pH, systemic and urinary    (may be increased)


Medical considerations/Contraindications
The medical considerations/contraindications included have been selected on the basis of their potential clinical significance (reasons given in parentheses where appropriate)— not necessarily inclusive (» = major clinical significance).


Except under special circumstances, this medication should not be used when the following medical problems exist:

For parenteral dosage form:
» Alkalosis, metabolic or respiratory{01}    (may be exacerbated)


» Chloride loss due to vomiting or continuous gastrointestinal suction{01}    (increased risk of severe alkalosis)


» Hypocalcemia    (increased risk of alkalosis producing tetany {01})


Risk-benefit should be considered when the following medical problems exist
» Anuria or oliguria    (increased risk of excessive sodium retention {01})


» Edematous sodium-retaining conditions such as:{01}
Cirrhosis of liver
Congestive heart failure
Renal function impairment
Toxemia of pregnancy
» Hypertension    (may be exacerbated)


For antacid use:
» Appendicitis or symptoms of    (sodium bicarbonate may complicate existing condition)


» Bleeding, gastrointestinal or rectal, undiagnosed

Patient monitoring
The following may be especially important in patient monitoring (other tests may be warranted in some patients, depending on condition; » = major clinical significance):

Arterial blood pH determinations and
Bicarbonate concentrations, serum    (periodic monitoring during parenteral administration is recommended to avoid overdosage and alkalosis)


pH determinations, urinary    (monitoring is recommended for dosage adjustment when sodium bicarbonate is used as a urinary alkalizer)


Renal function determinations    (recommended at periodic intervals with long-term use of frequent, repeated dosage)




Side/Adverse Effects
The following side/adverse effects have been selected on the basis of their potential clinical significance (possible signs and symptoms in parentheses where appropriate)—not necessarily inclusive:

Those indicating need for medical attention
With excessive parenteral administration
    
Hypokalemia (dryness of mouth; increased thirst; irregular heartbeat; mood or mental changes; muscle cramps or pain; weak pulse){04}

With large doses
    
Swelling of feet or lower legs



Those indicating need for medical attention only if they continue or are bothersome
Incidence less frequent
    
Increased thirst
    
stomach cramps





Overdose
For specific information on the agents used in the management of sodium bicarbonate overdose, see    • Potassium Chloride in Potassium Supplements monograph and/or
   • Calcium Gluconate in Calcium Supplements monograph.


For information on the management of overdose or unintentional ingestion, contact a Poison Control Center (see Poison Control Center Listing ).

Clinical effects of overdose
Clinical effects of overdose
With large doses or in renal insufficiency
    
Metabolic alkalosis (mood or mental changes; muscle pain or twitching; nervousness or restlessness; slow breathing; unpleasant taste; unusual tiredness or weakness){04}

With long-term use
    
Hypercalcemia associated with milk-alkali syndrome (frequent urge to urinate; continuing headache; continuing loss of appetite; nausea or vomiting; unusual tiredness or weakness)



Treatment of overdose
Stop administration of sodium bicarbonate and all other alkali. {01} {30}



Supportive care:
Hydration with sodium chloride 0.9% intravenous injection. {01} {36}



Specific treatment:
Parenteral administration of potassium chloride if hypokalemia present. {01} {36}

Parenteral administration of calcium gluconate if hypocalcemia is present, for severe alkalosis. {01} {36}

Parenteral administration of ammonium chloride {01} {36} or hydrochloric acid, {38} {39} for severe alkalosis.

Hemodialysis for severe alkalosis. {30} {39}



Patient Consultation
As an aid to patient consultation, refer to Advice for the Patient, Sodium Bicarbonate (Systemic).

In providing consultation, consider emphasizing the following selected information (» = major clinical significance):

Before using this medication
»   Conditions affecting use, especially:

Pregnancy—Chronic use may lead to systemic alkalosis; sodium may cause edema and weight gain





Use in children—Not recommended, because serious side effects may result

Other medications, especially ketoconazole, mecamylamine, methenamine, or oral tetracyclines
Other medical problems, especially anuria or oliguria, appendicitis, bleeding of gastrointestinal tract or rectum, chloride loss, edema, hypertension, hypocalcemia, or metabolic or respiratory alkalosis

Proper use of this medication
Following physician's or manufacturer's instructions

» Proper dosing
Missed dose: If on regular dosing schedule—Taking as soon as possible; not taking if almost time for next dose; not doubling doses

» Proper storage

For antacid use
» Compliance with therapy, especially for ulcer patients

Taking 1 and 3 hours after meals and at bedtime for maximum effectiveness (for ulcer patients)

Precautions while using this medication
Regular visits to physician to check progress during long-term therapy

» Not taking:    —within 1 to 2 hours of other oral medication
   —for a prolonged period of time because of increased possibility of side effects


Caution for sodium restriction

For antacid use
» Not taking:    —if symptoms of appendicitis are present; checking with physician for proper diagnosis
   —concurrently with large amounts of milk or milk products
   —for more than 2 weeks or if problem is recurring, unless otherwise directed by physician



Side/adverse effects
Signs of potential side effects, especially hypokalemia


General Dosing Information
Prolonged sodium bicarbonate therapy is not recommended because of the high risk of causing metabolic alkalosis or sodium overload. {01} {05}

In acute mild to moderate acidosis, oral treatment is preferred to intravenous therapy. In severe acute acidosis, sodium bicarbonate may be given intravenously.

For oral dosage forms only
Sodium bicarbonate is a fast-acting antacid, but has a short duration of effect. It has a high neutralizing capacity.

The maximum daily dosage of sodium is 200 mEq (l6.6 grams of sodium bicarbonate) in patients younger than 60 years of age and 100 mEq (8.3 grams of sodium bicarbonate) in patients 60 years of age or older. {03}

When sodium bicarbonate is used as an antacid, the maximum dosage allowed should not be taken for more than 2 weeks except with the advice or under the supervision of a physician. {03}

In the treatment of peptic ulcer disease, sodium bicarbonate may be administered 1 and 3 hours after meals and at bedtime. Additional doses of antacids may be administered to relieve the pain that may occur between the regularly scheduled doses.

For parenteral dosage forms only
Commercially available parenteral solutions are generally hypertonic and require dilution.

Sodium bicarbonate solution may be administered intravenously or, following dilution to isotonicity (1.5%), subcutaneously. {12}

For intravenous administration, suitable concentrations range from 1.5% (isotonic) to 8.4% (undiluted), depending on the clinical condition and requirements of the patient.

For subcutaneous administration, an isotonic solution (1.5%) of sodium bicarbonate may be prepared by diluting 1 mL of 8.4% sodium bicarbonate solution with 4.6 mL of sterile water for injection. However, it should be noted that absorption from subcutaneous administration is unpredictable. This route of administration is not generally recommended except in those cases where the intravenous route is not available. {12}

Bicarbonate therapy should always be planned in a careful, controlled way, since the degree of response to a given dose is not precisely predictable. Ideally, sodium bicarbonate should always be given according to the results of measurement of arterial blood pH, carbon dioxide content of the plasma, and calculation of base deficit. {01}

Excessive administration may induce hypokalemia and may predispose the patient to cardiac arrhythmias. {01}

Too rapid administration of sodium bicarbonate may produce severe alkalosis, which may be accompanied by hyperirritability or tetany. {01}

Overdosage and alkalosis may be avoided by giving repeated small doses. Periodic monitoring is recommended.

Rapid injection (10 mL per minute) of hypertonic sodium bicarbonate solutions may produce hypernatremia, a decrease in cerebrospinal fluid pressure, and possible intracranial hemorrhage, especially in neonates and children under 2 years of age. No more than 8 mEq per kg of body weight per day of a 4.2% solution should be administered. {01}

In cardiac arrest emergencies, the risk of rapid infusion may be necessary because of the fatality risk due to acidosis. {01}

Adequate alveolar ventilation must be ensured following sodium bicarbonate administration during cardiac arrest, to allow for the continued excretion of the carbon dioxide released. This is important for the control of arterial pH. {01}


Oral Dosage Forms

EFFERVESCENT SODIUM BICARBONATE

Usual adult and adolescent dose
Antacid
Oral, 3.9 to 10 grams in a glass of cold water after meals. {02}

Note: Patients 60 years of age and over—Oral, 1.9 to 3.9 grams after meals. {02}



Usual adult and adolescent prescribing limits
Oral, 19.5 grams per day. {02}

Usual pediatric dose
Antacid
Children up to 6 years of age: Dosage must be individualized by physician. {02}
Children 6 to 12 years of age: Oral, 1 to 1.9 grams in a glass of cold water after meals. {02}


Strength(s) usually available
U.S.—


780 mg of sodium bicarbonate and 1.82 grams of sodium citrate per teaspoonful (3.9 grams) (OTC) [Citrocarbonate]

Canada—


780 mg of sodium bicarbonate and 1.82 grams of sodium citrate per teaspoonful (3.9 grams) (OTC) [Citrocarbonate]

Packaging and storage:
Store below 40 °C (104 °F), preferably between 15 and 30 °C (59 and 86 °F), in a tight container, unless otherwise specified by manufacturer.

Note: Alert patients on sodium-restricted diet. Product contains 30.46 mEq (700.6 mg) of sodium per 3.9 grams. {02}



SODIUM BICARBONATE ORAL POWDER USP

Usual adult and adolescent dose
Antacid
Oral, 1/2 teaspoonful in a glass of water every two hours, the dose being adjusted as needed. {03}

Urinary alkalizer
Oral, 1 teaspoonful in a glass of water every four hours, the dose being adjusted as needed.


Usual adult prescribing limits
Up to 60 years of age—Up to 4 teaspoonfuls daily. {03}

Usual pediatric dose
Dosage has not been established.

Size(s) usually available:
U.S.—


120 grams (OTC) [Arm and Hammer Pure Baking Soda][Generic]


240 grams (OTC) [Arm and Hammer Pure Baking Soda][Generic]


480 grams (OTC) [Arm and Hammer Pure Baking Soda][Generic]


2400 grams (OTC) [Arm and Hammer Pure Baking Soda][Generic]

Canada—


Information not available[Generic]

Note: Each 1/2 teaspoonful contains 20.9 mEq (476 mg) of sodium.


Packaging and storage:
Store below 40 °C (104 °F), preferably between 15 and 30 °C (59 and 86 °F), unless otherwise specified by manufacturer. Store in a well-closed container.

Note: Alert patients on sodium-restricted diet. Products contain 41.8 mEq (952 mg) of sodium per teaspoonful. {03}



SODIUM BICARBONATE TABLETS USP

Usual adult and adolescent dose
Antacid
Oral, 325 mg to 2 grams one to four times a day. {10}

Urinary alkalizer
Oral, 4 grams initially, then 1 to 2 grams every four hours.


Usual adult prescribing limits
Up to 16 grams daily. {01}

Usual pediatric dose
Antacid
Children up to 6 years of age: Dosage has not been established.
Children 6 to 12 years of age: Oral, 520 mg; may be repeated once in thirty minutes. {11}

Urinary alkalizer
Oral, 1 to 10 mEq (23 to 230 mg) per kg of body weight per day, the dose being adjusted as needed.


Strength(s) usually available
U.S.—


325 mg (OTC) [Soda Mint][Generic]


520 mg (OTC) [Bell/ans]


650 mg (OTC)[Generic]

Canada—


500 mg (OTC)[Generic]

Packaging and storage:
Store below 40 °C (104 °F), preferably between 15 and 30 °C (59 and 86 °F), unless otherwise specified by manufacturer. Store in a well-closed container.

Note: Alert patients on sodium-restricted diet. Products contain sodium as follows: 325 mg tablets (3.9 mEq), 520 mg tablets (6.2 mEq), and 650 mg tablets (7.7 mEq). {10} {11}




Parenteral Dosage Forms

SODIUM BICARBONATE INJECTION USP

Usual adult and adolescent dose
Systemic alkalizer
In cardiac arrest: Intravenous, initially 1 mEq per kg of body weight; 0.5 mEq per kg of body weight may be repeated every ten minutes of continued arrest. {01}
In less urgent forms of metabolic acidosis: Intravenous infusion, 2 to 5 mEq per kg of body weight, administered over a period of four to eight hours. {01}
Note: Frequency of administration and the size of the dose may be reduced after severe symptoms have abated.



Urinary alkalizer
Intravenous, 2 to 5 mEq per kg of body weight, administered over a period of four to eight hours.


Usual pediatric dose
Systemic alkalizer
In cardiac arrest: Intravenous, 1 mEq per kg of body weight initially, then 0.5 mEq per kg of body weight every ten minutes of continued arrest. {01}
In less urgent forms of metabolic acidosis: Older children— See Usual adult and adolescent dose.

Urinary alkalizer
See Usual adult and adolescent dose.


Strength(s) usually available
U.S.—


4.2% (Rx)[Generic]


5% (Rx)[Generic]


7.5% (Rx)[Generic]


8.4% (Rx)[Generic]

Canada—


4.2% (Rx)[Generic]


7.5% (Rx)[Generic]


8.4% (Rx)[Generic]

Note: 

Concentration per mL
of Aqueous Solution
Sodium Content
(mg/mL)
4% (0.48 mEq)
11
4.2% (0.5 mEq)
11.5
5% (0.595 mEq)
13.8
7.5% (0.892 mEq)
20.5
8.4% (1 mEq)
23



Packaging and storage:
Store below 40 °C (104 °F), preferably between 15 and 30 °C (59 and 86 °F), unless otherwise specified by manufacturer. Protect from freezing.

Preparation of dosage form:
Sterile water for injection, sodium chloride injection, dextrose injection (5%), or other standard electrolyte solutions may be used as diluents. {12}

For dilution and preparation of injection, see manufacturer's package insert.

Stability:
A sterile 7.5% solution of sodium bicarbonate in polypropylene syringes may remain stable for up to 100 days if refrigerated (2 to 8 °C), or up to 45 days at room temperature. {12}

Stability may be increased by refrigerating the sodium bicarbonate injection and the syringes before preparation, rinsing the syringes twice with refrigerated sterile water for injection, minimizing the contact of the solution with air by expelling the air from the syringes, and taping the plunger in place to minimize its movement caused by escaping carbon dioxide. {12}

Solutions of sodium bicarbonate should not be boiled or heated. When heated, it may decompose and be converted to the carbonate.

Haze formation or precipitation may result when sodium bicarbonate is added to infusion solution containing calcium. {01}

Do not use the injection if it contains a precipitate. {01}

Incompatibilities:
Sodium bicarbonate is incompatible with acids, acidic salts, {12} many alkaloidal salts, {01} aspirin, atropine, {13} bismuth salicylate, calcium-containing solutions, {12} {13} dobutamine, {13} dopamine hydrochloride {12} {13}, epinephrine, {13} isoproterenol hydrochloride {13}, morphine sulfate, {13} norepinephrine bitartrate {13}, regular insulin {13}, and tubocurarine chloride.



Revised: 08/10/1994



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