Applies to sodium bicarbonate: granule, solution, tablet.

Serious side effects of Sodium bicarbonate

Along with its needed effects, sodium bicarbonate 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.

Check with your doctor as soon as possible if any of the following side effects occur while taking sodium bicarbonate:

• 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

Other side effects of Sodium bicarbonate

Some side effects of sodium bicarbonate may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects.

Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them:

Less common

• Increased thirst
• stomach cramps

For Healthcare Professionals

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

Metabolic

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]

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.^[Ref]

Respiratory

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]

Nervous system

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

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.^[Ref]

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.^[Ref]

Cardiovascular

Cardiovascular side effects have included decreased cardiac contractility possibly resulting from infusion of sodium bicarbonate 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

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]

Renal

Urinary alkalinization from bicarbonate can cause a falsely positive colorimetric assay for protein.^[Ref]

Renal side effects have rarely included "False proteinuria".^[Ref]