Sodium bicarbonate Side Effects

Some side effects of sodium bicarbonate may not be reported. Always consult your doctor or healthcare specialist for medical advice. You may also report side effects to the FDA.

For the Consumer

Applies to sodium bicarbonate: oral tablet

Stop taking sodium bicarbonate and seek emergency medical attention if you experience a rare allergic reaction (difficulty breathing; closing of the throat; swelling of the lips, tongue, or face; or hives).

Stop taking sodium bicarbonate and notify your doctor if you experience

• nausea or vomiting;

• headache;

• sever mood changes;

• muscle pain;

• swelling of feet, ankles or legs

• decreased appetite;

• unusual tiredness;

• constipation;

• dry mouth or increased thirst; or

• increased urination.

Side effects other than those listed here may also occur. Talk to your doctor about any side effect that seems unusual or that is especially bothersome.

For Healthcare Professionals

Applies to sodium bicarbonate: compounding powder, intravenous solution, oral tablet

Metabolic

Chronic ingestion of bicarbonate may rarely cause intravascular volume expansion with resultant hyporeninemia and hypoaldosteronemia. In this rare circumstance, the serum potassium may be elevated.

Rare cases of sodium bicarbonate abuse have been associated with features of Munchausen syndrome. These patients often present with an otherwise unexplained hypokalemic hypochloremic metabolic alkalosis.

Hypernatremia may cause water retention, weight gain, and edema, which may be important in some patients with congestive heart failure, renal insufficiency, or severe liver disease.

Metabolic side effects have included metabolic alkalosis, hypernatremia/hyperosmolarity, hypochloremia, and hypokalemia. These effects have been associated with rapid or prolonged administration. Side effects have rarely included intravascular volume expansion with resultant hyporeninemia and hypoaldosteronemia.

Respiratory

The respiratory drive may be suppressed after bicarbonate administration due to increased venous C02 concentration. Without adequate ventilation, worsened systemic acidosis could develop.

Respiratory side effects have included suppressed respiratory drive.

Nervous system

Rapid infusion of hyperosmolar sodium bicarbonate has been associated with intraventricular hemorrhage in the pediatric literature.

Irritability and tetany have been associated with sodium bicarbonate-induced alkalosis or hypernatremia.

Due to greater permeability of the blood-brain barrier to hydrogen than to bicarbonate, the pH of cerebrospinal fluid may significantly decrease during sodium bicarbonate administration, which can cause mental stupor or coma.

Nervous system side effects have included irritability, tetany, mental stupor, coma, and intraventricular hemorrhage.

Local

Local side effects have included IV site pain, venous irritation, and extravasation. Cellulitis, tissue necrosis, ulceration, or skin sloughing have possibly been the result of extravasation. A slow rate of administration of a properly diluted solution into a large bore needle and vein is recommended if IV administration is necessary.

Cardiovascular

Cardiovascular side effects have included decreased cardiac contractility possibly resulting from infusion of sodium bicarbonate in patients with severe acidosis.

Experimentally, the administration of intravenous hypertonic sodium bicarbonate has been associated with increased serum osmolality, decreased ionized serum calcium (which is associated with decreased myocardial contractility), and peripheral vasodilation. Some experts recommend invasive hemodynamic monitoring in acidotic patients before the administration of bicarbonate.

Gastrointestinal

Gastrointestinal side effects associated with oral administration have rarely included gastric rupture.

As an antacid, sodium bicarbonate, especially after excess food or liquid, can cause excess gas release (when combined with gastric acid). The mortality associated with gastric rupture is as high as 65%.

Renal

Urinary alkalinization from bicarbonate can cause a falsely positive colorimetric assay for protein.

Renal side effects have rarely included "False proteinuria".

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