From the FDA Drug Label
Directions: Adults - Take 1 tablet, dissolved in a glass of water, as needed. Maximum daily dose for adults upto 60 years of age is 24 tablets. Maximum daily dose for adults 60 years of age and older is 12 tablets. Warnings Do not use this product if you are on a sodium-restricted diet unless directed by a doctor. Do not take more than 24 tablets for adults up to 60 years of age (or 12 tablets for adults 60 years of age and older) in a 24-hour period nor use the maximum dosage for more than 2 weeks, except under the advice and supervision of a physician.
The maximum dose of sodium bicarbonate that can be given is:
- 24 tablets for adults up to 60 years of age
- 12 tablets for adults 60 years of age and older in a 24-hour period 1 1. Chronic Kidney Disease (CKD) is not explicitly mentioned in the provided drug labels.
From the Research
The maximum dose of sodium bicarbonate for chronic kidney disease (CKD) patients is typically 1.13 mmol/kg*bw/day, as evidenced by the most recent and highest quality study 2.
Key Considerations
- Treatment usually starts with a lower dose, with gradual titration based on serum bicarbonate levels.
- The goal is to maintain serum bicarbonate within the normal range of 22-26 mEq/L.
- Patients should take sodium bicarbonate after meals to minimize gastrointestinal side effects like bloating and flatulence.
- Regular monitoring of serum bicarbonate, potassium, and blood pressure is essential as sodium bicarbonate therapy can cause fluid retention, hypertension, and electrolyte imbalances.
Rationale
The study by 2 provides the most recent and comprehensive evidence on the safety and efficacy of sodium bicarbonate for treating metabolic acidosis in CKD. The results show that sodium bicarbonate significantly increases serum bicarbonate in CKD patients, with a favorable safety profile.
Important Details
- The study found no significant association between sodium bicarbonate therapy and adverse outcomes such as death, prolonged hospitalization, gastrointestinal disorders, or worsening edema 2.
- The optimal serum bicarbonate level for CKD patients is still a topic of debate, with some studies suggesting that targeting a level near 28 mEq/L may improve clinical outcomes 3.
- However, the most recent and highest quality study 2 supports the use of sodium bicarbonate at a dose of 1.13 mmol/kg*bw/day to correct metabolic acidosis and potentially slow CKD progression.
Monitoring and Titration
- Regular monitoring of serum bicarbonate, potassium, and blood pressure is crucial to adjust the dose of sodium bicarbonate and prevent potential side effects.
- The dose of sodium bicarbonate should be titrated based on serum bicarbonate levels, with the goal of maintaining a level within the normal range of 22-26 mEq/L.