Sodium bicarbonate adverse effects

A variety of adverse effects have been reported following the use of antacids. If sodium bicarbonate is absorbed, it can cause systemic alkalization and sodium overload. Calcium carbonate may induce hypercalcemia and a rebound increase in gastric secretion secondary to the elevation in circulating calcium levels. Magnesium hydroxide may produce osmotic diarrhea, and the excessive absorption of Mg++ in patients with renal failure may result in central nervous system toxicity. Aluminum hydroxide is associated with constipation serum phosphate levels also may become depressed because of phosphate binding within the gut. The use of antacids in general may interfere with the absorption of a number of antibiotics and other medications. 

Pentozocine Lactate Injections of pentozocine lactate are incompatible with sodium bicarbonate, barbiturates, diazepam, chlordiazepoxide, glycopyrronium bromide, and nafcillin sodium. Dependence, withdrawal, and treatment of adverse effects are generally similar to those of opioid analgesics. 

A substantial increment in the relative lifetime values of copper-impregnated samples is also observed after sodium bicarbonate treatment (Table XI). Thus, the copper-catalyzed system also benefits from the neutralization process. However, the change in relative stability values does not compare as favorably. A small but consistently adverse effect upon relative stability indicates that unlike iron species, ionic copper species can be more effective catalysts at lower acidic concentra-... 

The administration of tetracycline with food can ameliorate its irritative effects, bnt food can adversely affect the drug s absorption. In contrast, the absorption of doxycycline is only slightly affected by the presence of food, including dairy prodncts. Becanse all tetracyclines can form complexes with divalent cations, the absorption of any tetracycline is markedly decreased when administered with iron-containing tonics or antacids containing calcium, magnesium, or aluminum. Sodium bicarbonate also adversely affects tetracycline absorption. 

During initial therapy a fluid intake of at least 2 1/d should be ensured to prevent urate crystall-uria. If the uric acid load is high, consider rendering the urine alkaline with Potassium Citrate Mixture 12-24 g/d with water p.o. or sodium bicarbonate powder 5-10 g/d with water p.o., again to prevent uric acid crystal formation in the renal tract. Other adverse effects are mainly gastrointestinal sulfinpyrazone is contraindicated in peptic ulcer. 

Antacids are basic substances that reduce gastric acidity by neutralising HCl. The hydroxide is the most common base but trisilicate, carbonate and bicarbonate are also used. Therapeutic efficacy and adverse effects depend also on the metallic ion with which the base is combined, and this is usually aluminium, magnesium or sodium. Calcium and... 

It is the author s opinion that there are no grounds for using sodium bicarbonate to treat lactic acidosis, irrespective of the arterial (or venous) pH. This contradicts previous recommendations that it should be used when the pH decreases below 7.1 (Divers 1998) or 7.22 (Johnson 1995). The treatment of lactic acidosis with sodium bicarbonate is based on four suppositions low blood pH is directly harmful, sodium bicarbonate is able to increase blood pH when infused i.v., raising the blood pH with sodium bicarbonate improves patient status and any adverse effects of sodium bicarbonate are outweighed by its benefits (Forsythe Schmidt 2000). These suppositions are not supported by the data available currently in horses, humans and experimental animals. 

In theory, sodium bicarbonate administration provides fluid and electrolyte replacement and increases arterial pH, thereby improving cardiac function, perfusion and oxygenation of peripheral tissues, and intracellular pH, and should therefore decrease lactate production and increase clearance. However, sodium bicarbonate administration can actually have an adverse effect on intracellular pH. When bicarbonate is given by IV infusion, the carbon dioxide generated diffuses more readily than bicarbonate across cellmembranes and into cerebrospinal fluid. Therefore the intracellular pH can actually be decreased by administration of bicarbonate." ... 

The most frequently adverse reactions are those involving the Gl tract (e.g., abdominal pain, discomfort, and nausea) but appear to be less than those observed with aspirin. The CNS effects (e.g., dizziness and drowsiness) also are observed. Few cases of overdosage have been reported, but in such cases, recommended treatment includes elimination of the drug from the Gl tract by emesis or gastric lavage and elimination of the acidic drug from the circulatory system by enhancing alkalinization of the urine with sodium bicarbonate. 

Although changes in urinary pH can affect the amount of mexiletine lost in the urine, the effect of diet or the concurrent use of alkalinisers (sodium bicarbonate, acetazolamide) or acidifiers (ammonium chloride etc.) on the plasma concentrations of mexiletine does not appear to be predictable. There appear to be no reports of adverse interactions but concurrent use should be monitored. The UK manufacturer of mexiletine recommends that the concomitant use of drugs that markedly acidify or alkalinise the urine should be avoided. ... 

There appear to be no reports of adverse interactions between chlorpropamide and drugs that can alter urinary pH, but prescribers should be aware of the possibilities a reduced response if the pH is raised significantly and renal clearance predominates (e.g. with sodium bicarbonate, acetazolamide, some antacids) an increased response if the pH is made more acid than usual and metabolic clearance predominates (e.g. with ammonium chloride). Perhaps more importantly, the effects of drugs that alter the hepatic clearance of chlorpropamide are likely to be more significant when its renal clearance is low (i.e. when the urine is acid). ... 

Drugs that make the urine alkaline (e.g. sodium bicarbonate, carbonic anhydrase inhibitors) will reduce the elimination of memantine. Memantine should be used with caution with other NMDA antagonists, such as amantadine, ketamine and dextromethorphan, or concurrent use should be avoided, because of the theoretical increased risk of adverse effects. Memantine is predicted to interact with other drugs eliminated by the same renal secretion mechanism, but no important interaction was seen with glibenclamide, hydrochlorothiazide, metformin or triamterene. 

The interaction between ephedrine or pseudoephedrine and urinary alkalinisers are established but reports of adverse reactions in patients appear to be rare. Be aware that any increase in the adverse effects of these drugs (tremor, anxiety, insomnia, tachycardia, etc.) could be due to drug retention brought about by this interaction. Acetazolamide makes the urine alkaline and would be expected to interact with ephedrine and pseudoephedrine in the same way as sodium bicarbonate. 

Treatment of adverse events some common side effects may resolve over time or with lower doses. In addition to supportive therapy, the mainstay of treatment for severe toxicity is serum alkalinization with sodium bicarbonate to increase protein binding and decrease QRS intervaL Although no reversal agent exists, substances that may reverse cardiotoxicity are being studied. 

---