From the Guidelines
Sodium bicarbonate is not recommended for treating diarrhea, as it can potentially worsen symptoms by causing more fluid loss and disrupting the body's acid-base balance and electrolyte levels. The use of sodium bicarbonate in treating diarrhea is not supported by recent evidence, and its potential risks outweigh any potential benefits 1. Instead, oral rehydration solutions that approach the WHO-recommended electrolyte concentrations, such as Ceralyte, Pedialyte, or generic solutions, are recommended for treating dehydration caused by diarrhea 1. These solutions can be purchased at local pharmacies or prepared by a pharmacy using a mixture of NaCl, NaHCO3 (or Na citrate), KCl, and glucose or glucose polymer per liter of clean water.
Key Considerations for Diarrhea Treatment
- Oral rehydration solutions should be used to treat dehydration caused by diarrhea
- Patients should be asked about potential epidemiological risk factors for particular diarrheal diseases or their spread
- A thorough history, including both clinical and epidemiological features, should be obtained when evaluating a patient with significant diarrheal illness
- Relevant clinical features, such as stool characteristics, frequency of bowel movements, and presence of dysenteric symptoms, should be assessed
Recommended Treatment Approach
- Use oral rehydration solutions that approach the WHO-recommended electrolyte concentrations
- Stay hydrated with water and clear broths
- Gradually reintroduce bland foods like rice, toast, and bananas as symptoms improve
- Consider over-the-counter medications such as loperamide (Imodium) to reduce diarrhea frequency in adults
- Seek medical attention promptly if diarrhea is severe, persistent beyond 2-3 days, or accompanied by high fever, severe abdominal pain, or bloody stools.
From the Research
Relationship Between Sodium Bicarbonate and Diarrhea
- The use of sodium bicarbonate in the management of infants with diarrhea, dehydration, and metabolic acidosis was evaluated in a study 2, which demonstrated that the use of bicarbonate does not lead to a more rapid correction of the metabolic acidosis.
- The study also found that bicarbonate should not be used in patients with serum bicarbonate levels of 5 mEq/1 or over 2.
- There is no direct evidence in the provided studies that sodium bicarbonate is used to treat diarrhea, but rather to manage metabolic acidosis associated with dehydration in patients with diarrhea.
- Other studies focus on the clinical management of infectious diarrhea 3, the optimization of oral rehydration solutions for treating diarrhea 4, and the clinical approach to diagnosing chronic diarrhea 5, but do not mention the use of sodium bicarbonate as a treatment for diarrhea.
- A study on loperamide, a new antidiarrheal agent, found it to be effective in relieving symptoms of chronic diarrhea 6, but does not discuss the use of sodium bicarbonate.