From the Guidelines
The recommended oral dose of sodium bicarbonate is typically 2 to 4 g/d or 25 to 50 mEq/d, as this has been shown to effectively increase serum bicarbonate concentrations in individuals with metabolic acidosis 1. When considering the treatment of metabolic acidosis, it is essential to monitor serum bicarbonate levels regularly and aim to maintain them at or above 22 mmol/L.
- The goal of treatment is to normalize the predialysis or stabilized serum bicarbonate concentration, which can be achieved through higher dialysate concentrations and/or oral supplementation with bicarbonate salts.
- Correction of acidemia due to metabolic acidosis has been associated with several benefits, including increased serum albumin, decreased protein degradation rates, and increased plasma concentrations of branched chain amino acids and total essential amino acids 1.
- It is crucial to note that the oral dose of sodium bicarbonate may need to be adjusted based on individual patient needs and response to treatment.
- Patients with certain medical conditions, such as heart failure, kidney disease, or those on sodium-restricted diets, should use caution when taking sodium bicarbonate due to the potential for electrolyte imbalances and acid-base disturbances.
- The study by the National Kidney Foundation 1 provides the most relevant and up-to-date guidance on the use of sodium bicarbonate in the treatment of metabolic acidosis, and its recommendations should be followed in clinical practice.
From the FDA Drug Label
Directions: Adults - Take 1 tablet, dissolved in a glass of water, as needed. Drug Facts Active Ingredient (in each tablet) Sodium bicarbonate 10 gr (650 mg) The oral dose of sodium bicarbonate is 1 tablet (650 mg), dissolved in a glass of water, as needed 22.
- The maximum daily dose for adults up to 60 years of age is 24 tablets (15,600 mg), and for adults 60 years of age and older is 12 tablets (7,800 mg) 2.
From the Research
Oral Dose of Sodium Bicarbonate
- The oral dose of sodium bicarbonate can have various effects on the body, including the treatment of metabolic acidosis 3.
- Sodium bicarbonate ingestion can provoke metabolic alkalosis and alkaliuria, which may lead to renal stone formation 4.
- The use of sodium bicarbonate as an antacid can cause side effects such as fluid retention in the body, depending on the sodium content 4.
- In patients with renal insufficiency, sodium bicarbonate ingestion may lead to toxic serum concentrations of calcium and magnesium 4, 5.
- Treatment of metabolic acidosis with sodium bicarbonate has been shown to delay the progression of chronic kidney disease and improve kidney and patient survival 3.
Potential Risks and Interactions
- Sodium bicarbonate can interact with other medications by changing gastric pH, altering drug dissolution, or affecting drug elimination 6.
- High doses of sodium bicarbonate can lead to significant adverse effects, especially in patients with underlying diseases such as chronic renal failure 6, 5.
- The use of sodium bicarbonate as an antacid can also lead to phosphorus depletion, particularly in patients with renal insufficiency 4, 6, 5.
Therapeutic Use
- Sodium bicarbonate is commonly used to treat metabolic acidosis, and its use has been shown to be safe and effective in improving kidney and patient survival 3.
- The therapeutic use of sodium bicarbonate should be monitored closely, particularly in patients with renal insufficiency or other underlying diseases 6, 5, 3.