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{{Short description|Pharmaceutical drug}}
{{Drugbox
{{See also|Sodium bicarbonate}}
{{Use dmy dates|date=December 2019}}
{{Infobox drug
| Verifiedfields = changed
| Watchedfields = changed
| Watchedfields = changed
| verifiedrevid = 428668238
| verifiedrevid = 451608004
| IUPAC_name =
| drug_name =
| OtherNames =
| INN =
| type = <!-- empty -->
| image = SodiumBicarbonate.svg
| image = SodiumBicarbonate.svg
| width = 150
| width = 150
| image2 =
| alt =
| width2 = 150
| caption =


<!--Clinical data-->
<!-- Clinical data -->
| tradename =
| pronounce =
| pregnancy_AU =
| tradename = many
| Drugs.com = {{Drugs.com|monograph|sodium-bicarbonate}}
| pregnancy_US = C <!--Reference: drugs.com (more details in Reference list at bottom)-->
| legal_AU =
| MedlinePlus = a682001
| licence_CA = <!-- Health Canada may use generic or brand name (generic name preferred) -->
| legal_UK =
| licence_EU = <!-- EMA uses INN (or special INN_EMA) -->
| legal_US =
| DailyMedID = Sodium_bicarbonate
| licence_US = <!-- FDA may use generic or brand name (generic name preferred) -->
| pregnancy_AU = <!-- A / B1 / B2 / B3 / C / D / X -->
| pregnancy_AU_comment =
| pregnancy_US = C
| pregnancy_US_comment = <ref name="Drugs.com pregnancy">{{cite web | title=Sodium bicarbonate Use During Pregnancy | website=Drugs.com | date=28 November 2019 | url=https://www.drugs.com/pregnancy/sodium-bicarbonate.html | access-date=31 March 2020}}</ref>
| dependency_liability =
| addiction_liability =
| routes_of_administration = [[intravenous therapy|intravenous]]
| routes_of_administration = [[intravenous therapy|intravenous]]
| class =
| ATCvet =
| ATC_prefix = B05
| ATC_suffix = XA02
| ATC_supplemental = {{ATC|B05|CB04}}


<!--Pharmacokinetic data-->
<!-- Legal status -->
| legal_AU = <!-- S2, S3, S4, S5, S6, S7, S8, S9 or Unscheduled-->
| legal_AU_comment =
| legal_BR = <!-- OTC, A1, A2, A3, B1, B2, C1, C2, C3, C4, C5, D1, D2, E, F-->
| legal_BR_comment =
| legal_CA = <!-- OTC, Rx-only, Schedule I, II, III, IV, V, VI, VII, VIII -->
| legal_CA_comment =
| legal_DE = <!-- Anlage I, II, III or Unscheduled-->
| legal_DE_comment =
| legal_NZ = <!-- Class A, B, C -->
| legal_NZ_comment =
| legal_UK = <!-- GSL, P, POM, CD, CD Lic, CD POM, CD No Reg POM, CD (Benz) POM, CD (Anab) POM or CD Inv POM / Class A, B, C -->
| legal_UK_comment =
| legal_US = Rx-only
| legal_US_comment =
| legal_UN = <!-- N I, II, III, IV / P I, II, III, IV-->
| legal_UN_comment =
| legal_status = <!-- For countries not listed above -->

<!-- Pharmacokinetic data -->
| bioavailability = 100% (intravenous)
| bioavailability = 100% (intravenous)
| protein_bound =
| protein_bound =
| metabolism =
| metabolism =
| metabolites =
| elimination_half-life =
| excretion =
| onset =
| elimination_half-life =
| duration_of_action =
| excretion =


<!--Identifiers-->
<!-- Identifiers -->
| CAS_number_Ref = {{cascite|changed|??}}
| CASNo_Ref =
| CAS_number =
| CAS_number = 144-55-8
| ATC_prefix =
| CAS_supplemental =
| ATC_suffix =
| PubChem = 516892
| PubChem =
| IUPHAR_ligand =
| DrugBank_Ref = {{drugbankcite|correct|drugbank}}
| DrugBank_Ref = {{drugbankcite|changed|drugbank}}
| DrugBank =
| DrugBank = DB01390
| ChemSpiderID_Ref = {{chemspidercite|correct|chemspider}}
| ChemSpiderID_Ref = {{chemspidercite|changed|chemspider}}
| ChemSpiderID = 8609
| UNII_Ref = {{fdacite|correct|FDA}}
| UNII_Ref = {{fdacite|correct|FDA}}
| UNII =
| UNII = 8MDF5V39QO
| KEGG_Ref = {{keggcite|correct|kegg}}
| KEGG_Ref =
| KEGG =
| KEGG = D01203
| KEGG2_Ref =
| ChEBI_Ref = {{ebicite|correct|EBI}}
| ChEBI =
| KEGG2 = C12603
| ChEBI_Ref =
| ChEMBL_Ref = {{ebicite|correct|EBI}}
| ChEMBL =
| ChEBI = 32139
| synonyms =
| ChEMBL_Ref =
| ChEMBL = 1353
| NIAID_ChemDB =
| PDB_ligand =
| synonyms = sodium hydrogen carbonate, monosodium carbonate


<!--Chemical data-->
<!-- Chemical and physical data -->
| IUPAC_name = sodium hydrogen carbonate
| C=1 | H=1 | Na=1 | O=3
| C=1 | H=1 | Na=1 | O=3
| molecular_weight = 84.01 g/mol
| SMILES = C(=O)(O)[O-].[Na+]
| smiles =
| InChI =
| Jmol =
| StdInChI = 1S/CH2O3.Na/c2-1(3)4;/h(H2,2,3,4);/q;+1/p-1
| InChIKey =
| StdInChI_comment =
| StdInChI_Ref = {{stdinchicite|correct|chemspider}}
| StdInChIKey = UIIMBOGNXHQVGW-UHFFFAOYSA-M
| StdInChI =
| density =
| StdInChIKey_Ref = {{stdinchicite|correct|chemspider}}=
| StdInChIKey =
| density_notes =
| melting_point =
| melting_point =
| boiling_point =
| melting_high =
| boiling_notes =
| melting_notes =
| solubility =
| boiling_point =
| boiling_notes =
| solubility =
| sol_units =
| specific_rotation =
}}
}}
'''Intravenous sodium bicarbonate''' (trade names including '''Baros''') is a solution for [[intravenous administration]] that increases plasma [[bicarbonate]], [[buffer]]s excess [[hydrogen ion]] concentration, raises [[blood pH]] and reverses the clinical manifestations of [[acidosis]].<ref name=drugs/>


<!-- Definition and medical uses -->
==Composition==
'''Intravenous sodium bicarbonate''', also known as '''sodium hydrogen carbonate''', is a medication primarily used to treat severe [[metabolic acidosis]].<ref name=WHO2008>{{cite book | title = WHO Model Formulary 2008 | year = 2009 | isbn = 9789241547659 | vauthors = ((World Health Organization)) | veditors = Stuart MC, Kouimtzi M, Hill SR | hdl = 10665/44053 | author-link = World Health Organization | publisher = World Health Organization |pages=489–492}}</ref> For this purpose it is generally only used when the [[pH]] is less than 7.1 and when the underlying cause is either [[diarrhea]], [[vomiting]], or the [[renal tubular acidosis|kidneys]].<ref name=BNF69/> Other uses include [[high blood potassium]], [[tricyclic antidepressant overdose]], and [[cocaine toxicity]] as well as a number of other [[poisoning]]s.<ref name=WHO2008/><ref>{{cite journal | vauthors = Bruccoleri RE, Burns MM | title = A Literature Review of the Use of Sodium Bicarbonate for the Treatment of QRS Widening | journal = Journal of Medical Toxicology | volume = 12 | issue = 1 | pages = 121–129 | date = March 2016 | pmid = 26159649 | pmc = 4781799 | doi = 10.1007/s13181-015-0483-y }}</ref><ref name=Dar2014/> It is given by [[intravenous administration|injection into a vein]].<ref name=BNF69>{{cite book|title=British National Formulary: BNF 69|date=2015|publisher=British Medical Association |isbn=9780857111562 | page=684 | edition=69th }}</ref>
It is administered as a [[hypertonic solution]] of [[sodium bicarbonate]], most commonly in concentrations of 4.2%, 5.0%, 7.5% or 8.4%.<ref name=drugs>[http://www.drugs.com/pro/sodium-bicarbonate.html Sodium Bicarbonate, Dosage Form: injection, solution] from [[Drugs.com]]. Revised: 03/2011 by General Injectables & Vaccines, Inc.</ref>


<!-- Side effects and mechanism -->
The solutions generally contain no [[antimicrobial agent]] or other added buffer.<ref name=drugs/>
Side effects may include [[low blood potassium]], [[high blood sodium]], and [[edema|swelling]].<ref name=WHO2008/><ref name=Dar2014>{{cite book| vauthors = Liebelt EL | chapter = Sodium Bicarbonate | veditors = Dart RC |title=Medical Toxicology|date=2014|publisher=Lippincott Williams & Wilkins|isbn=9780781728454|page=257| chapter-url=https://books.google.com/books?id=BfdighlyGiwC&pg=PA257|language=en|url-status=live|archive-url=https://web.archive.org/web/20170116163102/https://books.google.ca/books?id=BfdighlyGiwC&pg=PA257|archive-date=2017-01-16}}</ref> It is not recommended for people with [[low blood calcium]] level.<ref name="AHFS2017" /> Sodium bicarbonate is in the [[alkalinizing agent|alkalinizing]] family of medications.<ref name="AHFS2017" /> It works by increasing blood [[bicarbonate]], which [[Buffer solution|buffers]] excess [[hydrogen ion]] and raises [[blood pH]].<ref name=AHFS2017>{{cite web|title=Sodium Bicarbonate|url=https://www.drugs.com/monograph/sodium-bicarbonate.html|publisher=The American Society of Health-System Pharmacists|access-date=8 January 2017|url-status=live|archive-url=https://web.archive.org/web/20170118040141/https://www.drugs.com/monograph/sodium-bicarbonate.html|archive-date=18 January 2017}}</ref>


<!-- History and culture -->
==Mechanism of action==
Commercial production of sodium bicarbonate began between 1791 and 1823.<ref>{{cite book| vauthors = Ihde AJ | chapter = Chemical Industry I: The Nineteenth Century |title=The Development of Modern Chemistry|date=1970|publisher=Courier Corporation| page = 447 |isbn=9780486642352| chapter-url=https://books.google.com/books?id=89BIAwAAQBAJ&pg=PA447|language=en|url-status=live|archive-url=https://web.archive.org/web/20170116165051/https://books.google.ca/books?id=89BIAwAAQBAJ&pg=PA447|archive-date=2017-01-16}}</ref> Intravenous medical use began around the 1950s.<ref name=Dar2014/> It is on the [[WHO Model List of Essential Medicines|World Health Organization's List of Essential Medicines]].<ref name="WHO21st">{{cite book | vauthors = ((World Health Organization)) | title = World Health Organization model list of essential medicines: 21st list 2019 | year = 2019 | hdl = 10665/325771 | author-link = World Health Organization | publisher = World Health Organization | location = Geneva | id = WHO/MVP/EMP/IAU/2019.06. License: CC BY-NC-SA 3.0 IGO | hdl-access=free }}</ref> Sodium bicarbonate is available as a [[generic medication]].<ref name=AHFS2017/>
After injection, intravenous sodium bicarbonate dissociates to provide sodium (Na<sup>+</sup>) and bicarbonate (HCO<sub>3</sub><sup>-</sup>) [[anion]]s. Bicarbonate anions can consume hydrogen inons (H<sup>+</sup>) and thereby be converted to [[carbonic acid]] (H<sub>2</sub>CO<sub>3</sub>), which can subsequently be converted to water (H<sub>2</sub>O) and carbon dioxide (CO<sub>2</sub>) which can be excreted by the lung.<ref name=drugs/>


==Indications==
==Medical uses==
Intravenous sodium bicarbonate is indicated in the treatment of [[metabolic acidosis]], such as can occur in, for example, severe [[renal disease]], [[diabetic ketoacidosis]], [[circulatory insufficiency]], [[extracorporeal circulation]] of blood, in [[hemolysis]] requiring alkalinization of the urine to avoid [[nephrotoxicity]] of blood pigments, and certain [[drug intoxication]]s, such as by [[barbiturate overdose]], [[salicylate poisoning]] or [[methanol poisoning]].<ref name=drugs/> In addition, sodium bicarbonate is indicated in severe [[diarrhea]], where large amounts of bicarbonate may be lost.<ref name=drugs/> However, overall treatment should also strive to treat the underlying cause of the acidosis, such as giving [[insulin]] in case of [[diabetic ketoacidosis]].<ref name=drugs/>
Intravenous sodium bicarbonate is indicated in the treatment of [[metabolic acidosis]], such as can occur in severe [[kidney disease]], [[diabetic ketoacidosis]]{{Citation needed|date=July 2021}}, [[circulatory insufficiency]], [[extracorporeal circulation]] of blood, in [[hemolysis]] requiring alkalinization of the urine to avoid [[nephrotoxicity]] of blood pigments, and certain [[drug intoxication]]s, such as by [[barbiturate overdose]], [[salicylate poisoning]], [[tricyclic antidepressant overdose]] or [[methanol poisoning]].<ref name=drugs/> In addition, sodium bicarbonate is indicated in severe [[diarrhea]], where large amounts of bicarbonate may be lost.<ref name=drugs/> However, overall treatment should also strive to treat the underlying cause of the acidosis, such as giving [[insulin]] in case of [[diabetic ketoacidosis]].<ref name=drugs/>


==Precautions==
=== Dhaka fluid ===
{{Infobox
===Contraindications===
|title= Dhaka fluid<ref name=Tri2015/>
|header1 = Concentration in millimoles per litre
|header2 =
| label2 = Sodium Chloride
| data2 = 85 mM
|header3 =
| label3 = Potassium Chloride
| data3 = 13 mM
|header4 =
| label4 = Sodium bicarbonate
| data4 = 48 mM
|header5 =
| label5 =Solvent
| data5 =1 Litre of water or 5 percent glucose solution.
}}

Dhaka fluid is one of the [[IV fluids]] used in intravenous rehydration therapy which has sodium bicarbonate content in it.<ref name=Tri2015>{{cite book| vauthors = Tripathi KD |title=Essentials of Medical Pharmacology|date=2015|publisher=Jaypee Brothers Medical Publishers (P) Ltd|location=New Delhi|isbn=978-93-5025-937-5|page=679|edition=Seventh}}</ref> Used as a resuscitative fluid in burn management.<ref>{{Cite journal| vauthors = Shahidul BM |date=December 2003|title=Fluid Resuscitation of Burn Patients in Bangladesh - "Dhaka Fluid Therapy", An Alternative Approach|journal=Annals of Burns and Fire Disaster|volume=26|pages=173–181|s2cid=2902069}}</ref>

==Contraindications==
Intravenous sodium bicarbonate is contraindicated in patients who are losing [[chloride]], such as by vomiting.<ref name=drugs/>
Intravenous sodium bicarbonate is contraindicated in patients who are losing [[chloride]], such as by vomiting.<ref name=drugs/>


Because of its sodium content, intravenous sodium bicarbonate should be used with great care, if at all, in patients with [[congestive heart failure]] and severe [[renal insufficiency]], where [[Low sodium diet|low sodium intake]] is strongly indicated to prevent [[sodium retention]].<ref name=drugs/> By similar rationale, intravenous sodium bicarbonate should be given with caution to patients receiving [[corticosteroids]].<ref name=drugs/>
Because of its sodium content, intravenous sodium bicarbonate should be used with great care, if at all, in patients with [[congestive heart failure]] and severe [[chronic kidney disease]], where [[Low sodium diet|low sodium intake]] is strongly indicated to prevent [[sodium retention]].<ref name=drugs/> By similar rationale, intravenous sodium bicarbonate should be given with caution to patients receiving [[corticosteroids]].<ref name=drugs/>


===Overdosing===
==Side effects==
Overdose of intravenous sodium bicarbonate results in solute and/or [[fluid overload]], potentially leading to [[edema]], including [[pulmonary edema]].<ref name=drugs/> Also, it can cause [[metabolic alkalosis]] (with signs including [[muscular twitching]]s, [[irritability]] and [[tetany]]).<ref name=drugs/> [[Hypernatremia]] is also possible.<ref name=drugs/> Repeated fractional doses and frequent monitoring by laboratory tests are recommended to minimize the possibility of overdosing.<ref name=drugs/>
[[Extravasation]] of intravenous sodium bicarbonate has been reported to cause [[chemical cellulitis]] because of its alkalinity, resulting in tissue [[necrosis]], [[ulceration]] and/or [[sloughing]] at the site of infiltration. This condition is managed by prompt elevation of the part, warmth and local injection of [[lidocaine]] or [[hyaluronidase]].<ref name=drugs/>


== Interactions ==
Rapid administration (equal to or exceeding 10 mL/min) of intravenous sodium bicarbonate into neonates and children under two years of age may produce [[hypernatremia]], resulting in a decrease in [[cerebrospinal fluid pressure]] and, possibly, [[intracranial hemorrhage]]. Therefore, the rate of administration to such patients should not exceed 8 mEq/kg/day, unless a very strong indication is present.<ref name=drugs/>


===Interactions===
Norepinephrine and dobutamine cannot be used as additives in an intravenous sodium bicarbonate solution.<ref name=drugs/>
Norepinephrine and dobutamine cannot be used as additives in an intravenous sodium bicarbonate solution.<ref name=drugs/>


Intravenous sodium bicarbonate should not be mixed with [[calcium]], as they may [[Precipitation (chemistry)|precipitate]], except where compatibility has been previously established for the preparations at hand.<ref name=drugs/>
Intravenous sodium bicarbonate should not be mixed with [[calcium]], as they may [[Precipitation (chemistry)|precipitate]], except where compatibility has been previously established for the preparations at hand.<ref name=drugs/>


==Overdosing==
===Other adverse reactions===
[[Extravasation]] of intravenous sodium bicarbonate has been reported to cause [[chemical cellulitis]] because of its alkalinity, resulting in tissue [[necrosis]], [[ulceration]] and/or [[sloughing]] at the site of infiltration. This condition is managed by prompt elevation of the part, warmth and local injection of [[lidocaine]] or [[hyaluronidase]].<ref name=drugs/>
Overdose of intravenous sodium bicarbonate results in solute and/or [[fluid overload]], potentially leading to [[edema]], including [[pulmonary edema]].<ref name=drugs/> Also, it can cause [[metabolic alkalosis]] (with signs including [[muscular twitching]]s, [[irritability]] and [[tetany]]).<ref name=drugs/> [[Hypernatremia]] is also possible.<ref name=drugs/> Repeated fractional doses and frequent monitoring by laboratory tests are recommended to minimize the possibility of overdosing.<ref name=drugs/>


Rapid administration (equal to or exceeding 10 mL/min) of intravenous sodium bicarbonate into neonates and children under two years of age may produce [[hypernatremia]], resulting in a decrease in [[cerebrospinal fluid pressure]] and, possibly, [[intracranial hemorrhage]]. Therefore, the rate of administration to such patients should not exceed 8 mEq/kg/day, unless a very strong indication is present.<ref name=drugs/>
==References==
{{reflist}}


==External links==
==Composition==
It is administered as a [[hypertonic solution]] of [[sodium bicarbonate]], most commonly in concentrations of 4.2%, 5.0%, 7.5% or 8.4%.<ref name=drugs>{{cite web | url = https://www.drugs.com/pro/sodium-bicarbonate.html | title = Sodium Bicarbonate, Dosage Form: injection, solution by General Injectables & Vaccines, Inc.| archive-url = https://web.archive.org/web/20110303061531/http://www.drugs.com/pro/sodium-bicarbonate.html | archive-date = 3 March 2011 | work = [[Drugs.com]] | date= March 2011 }} </ref>
*[http://www.drugs.com/pro/sodium-bicarbonate.html Intravenous sodium bicarbonate at Drugs.com], with more detailed dosages


The solutions generally contain no [[antimicrobial agent]] or other added buffer.<ref name=drugs/>
{{Intravenous therapy}}


==Mechanism of action==
After injection, intravenous sodium bicarbonate dissociates to provide sodium (Na<sup>+</sup>) and bicarbonate (HCO<sub>3</sub><sup>−</sup>) [[anion]]s. Bicarbonate anions can consume hydrogen ions (H<sup>+</sup>) and thereby be converted to [[carbonic acid]] (H<sub>2</sub>CO<sub>3</sub>), which can subsequently be converted to water (H<sub>2</sub>O) and carbon dioxide (CO<sub>2</sub>) which can be excreted by the lungs.<ref name=drugs/>


==Society and culture==
The Italian physician [[Tullio Simoncini]] has claimed that intravenous sodium bicarbonate is an effective [[cancer]] therapy. This is rejected by mainstream medicine.<ref>{{cite web | url=http://www.cancer.org/treatment/treatmentsandsideeffects/complementaryandalternativemedicine/herbsvitaminsandminerals/sodium-bicarbonate | title=Sodium Bicarbonate | work=[[American Cancer Society]]|archive-url=https://web.archive.org/web/20140203155835/http://www.cancer.org/treatment/treatmentsandsideeffects/complementaryandalternativemedicine/herbsvitaminsandminerals/sodium-bicarbonate|archive-date=3 February 2014 | access-date=20 March 2014}}</ref> Simoncini has been imprisoned twice for culpable manslaughter of people affected by cancer.<ref>{{cite news | vauthors = Lavinia G |newspaper=[[Corriere della Sera]] |location=Milan |title=Medico condannato: omicidio colposo |trans-title=Doctor convicted: manslaughter |date=21 May 2006 |url=http://archiviostorico.corriere.it/2006/maggio/21/Medico_condannato_omicidio_colposo_co_10_060521029.shtml |language=it}}</ref><ref>{{cite web |title=Doc gets 5 yrs for treating cancer| date=15 January 2018 | work=ANSA.it| url=http://www.ansa.it/english/news/general_news/2018/01/15/doc-gets-5-yrs-for-treating-cancer_5a91a283-1572-4a99-ac63-5653fcdf5b3a.html}}</ref>

== References ==
{{Reflist}}

== External links ==
*[https://www.drugs.com/pro/sodium-bicarbonate.html Intravenous sodium bicarbonate at Drugs.com], with more detailed dosages

{{Intravenous therapy}}


{{portal bar|Medicine}}


[[Category:Alternative cancer treatments]]
[[Category:Intravenous fluids]]
[[Category:Intravenous fluids]]
[[Category:World Health Organization essential medicines]]
[[Category:Wikipedia medicine articles ready to translate]]
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