From the Guidelines
Sodium bicarbonate should be given to patients with specific medical conditions, such as metabolic acidosis, certain types of kidney disease, and high potassium levels, and it is generally safe to continue this medication up until surgery in most cases, but the decision should always be made by a healthcare provider based on the patient's specific situation. Sodium bicarbonate is commonly used to treat metabolic acidosis, a condition where there's too much acid in the body 1. It's also used for certain types of kidney disease, during cardiac arrest, and to manage high potassium levels. Additionally, it can help with indigestion as an antacid, treat certain drug overdoses, and prevent kidney damage from some medications.
Key Points to Consider
- The use of sodium bicarbonate in cardiac arrest is not recommended as a routine practice, except in special situations such as preexisting metabolic acidosis, hyperkalemia, or tricyclic antidepressant overdose 1.
- In patients with hypoperfusion-induced lactic acidemia, sodium bicarbonate therapy is not recommended to improve hemodynamics or reduce vasopressor requirements if the pH is ≥ 7.15 1.
- The decision to hold sodium bicarbonate before surgery should be made by a healthcare provider based on the patient's specific situation, taking into account the underlying condition, type of surgery, and other medications being taken.
- Sudden discontinuation of sodium bicarbonate could potentially worsen acid-base balance in patients who need it for metabolic acidosis or kidney disease.
Special Considerations
- In patients with diabetic ketoacidosis, bicarbonate therapy may be beneficial if the pH is < 6.9, but it is not necessary if the pH is > 7.0 1.
- It is essential to discuss all medications, including sodium bicarbonate, with the surgical team during the pre-operative evaluation to receive personalized guidance.
From the FDA Drug Label
Indications: Relieves: acid indigestion heartburn sour stomach upset stomach associated with these symptoms Sodium bicarbonate is given to relieve acid indigestion, heartburn, sour stomach, and upset stomach associated with these symptoms.
- The FDA drug label does not provide information about holding sodium bicarbonate before surgery 2. The FDA drug label does not answer the question about holding sodium bicarbonate before surgery.
From the Research
Sodium Bicarbonate Administration
- Sodium bicarbonate is used to treat metabolic acidosis, although its use is not always beneficial and may cause harm in certain scenarios 3.
- It can be administered as a hypertonic push, as a resuscitation fluid, or as an infusion 3.
- Sodium bicarbonate may be beneficial in patients with cardiac arrest secondary to sodium channel blockade or hyperkalemia, as well as in patients with concomitant acute kidney injury and lactic acidosis 3.
Preoperative Administration
- Preoperative administration of sodium bicarbonate, in the form of Alka-Seltzer Effervescent, can increase the pH of gastric contents in patients undergoing emergency surgery, reducing the risk of acid aspiration 4.
- However, the use of sodium bicarbonate as an antacid before surgery should be carefully considered, as it may not be necessary in all cases and could potentially cause harm 4.
Comparison with Other Treatments
- Sodium bicarbonate has been compared to other treatments, such as Carbicarb, in the management of metabolic acidosis, with mixed results 5.
- Isotonic sodium bicarbonate infusion has been shown to improve perioperative acid-base balance and reduce the incidence of postoperative acute kidney injury and vasopressor requirement in patients undergoing emergency laparotomy for perforation peritonitis 6.
Risks and Benefits
- The use of sodium bicarbonate is associated with potential benefits, such as reversing acidosis-induced myocardial depression and hemodynamic instability, but also with potential harms, such as paradoxical respiratory acidosis, intracellular acidosis, and hypokalemia 7.
- The decision to administer sodium bicarbonate should be based on a careful consideration of the potential risks and benefits, as well as the underlying cause of the metabolic acidosis 7.