Bell / ans Side Effects
Generic Name: sodium bicarbonate
Note: This page contains information about the side effects of sodium bicarbonate. Some of the dosage forms included on this document may not apply to the brand name Bell / ans.
For the Consumer
Applies to sodium bicarbonate: capsule, granule, powder, solution, tablet
Along with its needed effects, sodium bicarbonate (the active ingredient contained in Bell / ans) may cause some unwanted effects. Although the following side effects occur very rarely when this medicine is taken as recommended, they may be more likely to occur if it is taken: in large doses, for a long time, or by patients with kidney disease.
If any of the following side effects occur while taking sodium bicarbonate, check with your doctor or nurse as soon as possible:
- Frequent urge to urinate
- headache (continuing)
- loss of appetite (continuing)
- mood or mental changes
- muscle pain or twitching
- nausea or vomiting
- nervousness or restlessness
- slow breathing
- swelling of feet or lower legs
- unpleasant taste
- unusual tiredness or weakness
Minor Side Effects
Some of the side effects that can occur with sodium bicarbonate may not need medical attention. As your body adjusts to the medicine during treatment these side effects may go away. Your health care professional may also be able to tell you about ways to reduce or prevent some of these side effects. If any of the following side effects continue, are bothersome or if you have any questions about them, check with your health care professional:Less common:
- Increased thirst
- stomach cramps
For Healthcare Professionals
Applies to sodium bicarbonate: compounding powder, intravenous solution, oral tablet
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 (the active ingredient contained in Bell / ans) 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.[Ref]
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.[Ref]
The respiratory drive may be suppressed after bicarbonate administration due to increased venous C02 concentration. Without adequate ventilation, worsened systemic acidosis could develop.[Ref]
Respiratory side effects have included suppressed respiratory drive.[Ref]
Rapid infusion of hyperosmolar sodium bicarbonate (the active ingredient contained in Bell / ans) 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.[Ref]
Nervous system side effects have included irritability, tetany, mental stupor, coma, and intraventricular hemorrhage.[Ref]
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.[Ref]
Cardiovascular side effects have included decreased cardiac contractility possibly resulting from infusion of sodium bicarbonate (the active ingredient contained in Bell / ans) in patients with severe acidosis.[Ref]
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.[Ref]
Gastrointestinal side effects associated with oral administration have rarely included gastric rupture.[Ref]
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%.[Ref]
Urinary alkalinization from bicarbonate can cause a falsely positive colorimetric assay for protein.[Ref]
Renal side effects have rarely included "False proteinuria".[Ref]
1. Wu DJ, Mifune J, Taga K, Hifumi S, Takahashi Y, Yamashida S, Nishioka S, Murakami T, Tanaka T "Anginal attack following a sodium bicarbonate and hydrocortisone injection." Jpn Heart J 31 (1990): 109-13
2. Kennedy S "Sodium bicarbonate abuse in anorexia nervosa." J Clin Psychiatry 49 (1988): 168
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6. Arieff AI "Managing metabolic acidosis: update on the sodium bicarbonate controversy." J Crit Illn 8 (1993): 224-46
7. Cooper DJ, Walley KR, Wiggs BR, Russell JA "Bicarbonate does not improve hemodynamics in critically ill patients who have lactic acidosisis." Ann Intern Med 112 (1990): 492-8
8. Thomas SH, Stone CK "Acute toxicity from baking soda ingestion." Am J Emerg Med 12 (1994): 57-9
9. Oster JR, Perez GO, Rosen MS "Hyporeninemic hypoaldosteronism after chronic sodium bicarbonate abuse." Arch Intern Med 136 (1976): 1179-80
10. Okada H, Inoue T, Takahira S, Sugahara S, Nakamoto H, Suzuki H "Daytime hypertension, sleep apnea and metabolic alkalosis in a haemodialysis patient - the result of sodium bicarbonate abuse." Nephrol Dialysis Transplant 14 (1999): 452-4
11. Griffith J, White P "Acute asthma precipitated by accidental inhalation of sodium bicarbonate granules (Carbex)." Clin Radiol 49 (1994): 435
12. Lou HC, Lassen NA, Fris-Hansen B "Decreased cerebral blood flow after administration of sodium bicarbonate in the distressed newborn infant." Acta Neurol Scand 57 (1978): 239-47
13. Papile LA, Burstein J, Burstein R, Koffler H, Koops B "Relationship of intravenous sodium bicarbonate infusions and cerebral intraventricular hemorrhage." J Pediatr 93 (1978): 834-6
14. Speer ME, Rudolph AJ "Calcification of superficial scalp veins secondary to intravenous infusion of sodium bicarbonate and calcium chloride." Cutis 32 (1983): 65-6
15. Prakash P, Saxena S "Complication of sodium bicarbonate therapy--a case report." Indian J Pediatr 45 (1978): 277-8
16. Cooper DJ, Worthley LI "Adverse haemodynamic effects of sodium bicarbonate in metabolic acidosis." Intensive Care Med 13 (1987): 425-7
17. Rao RS, Graver ML, Urivetsky M, Scharf SM "Mechanisms of myocardial depression after bolus injection of sodium bicarbonate." J Crit Care 9 (1994): 255-61
18. Bleske BE, Warren EW, Rice TL, Gilligan LJ, Tait AR "Effect of high-dose sodium bicarbonate on the vasopressor effects of epinephrine during cardiopulmonary resuscitation." Pharmacotherapy 15 (1995): 660-4
19. Fordtran JS, Morawski SG, Santa Ana CA, Rector FC, Jr "Gas production after reaction of sodium bicarbonate and hydrochloric acid." Gastroenterology 87 (1984): 1014-21
20. Lazebnik N, Iellin A, Michowitz M "Spontaneous rupture of the normal stomach after sodium bicarbonate ingestion." J Clin Gastroenterol 8 (1986): 454-6
21. Mastrangelo MR, Moore EW "Spontaneous rupture of the stomach in a healthy adult man after sodium bicarbonate ingestion." Ann Intern Med 101 (1984): 649-50
22. Brismar B, Strandberg A, Wiklund B "Stomach rupture following ingestion of sodium bicarbonate." Acta Chir Scand Suppl 530 (1986): 97-9
23. Downs NM, Stonebridge PA "Gastric rupture due to excessive sodium bicarbonate ingestion." Scott Med J 34 (1989): 534-5
Not all side effects for Bell / ans may be reported. You should always consult a doctor or healthcare professional for medical advice. Side effects can be reported to the FDA here.
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