Alkasol (Sodium Bicarbonate) Oral Dosing and Administration
For adults up to 60 years: dissolve 1 tablet completely in water as needed, with a maximum of 24 tablets per day; for adults 60 years and older, the maximum is 12 tablets per day. 1
Standard Adult Dosing
- Dissolve 1 tablet completely in a full glass of water before drinking - never swallow tablets whole or partially dissolved 1
- Adults under 60 years may take up to 24 tablets daily as the maximum dose 1
- Adults 60 years and older are limited to 12 tablets daily maximum 1
- Take tablets as needed rather than on a fixed schedule 1
Pediatric Considerations
- Alkasol tablets are not recommended for children according to the FDA label 1
- For pediatric patients requiring sodium bicarbonate therapy, alternative formulations must be used, with dosing of 1-2 mEq/kg IV for severe metabolic acidosis 2
- Newborns and infants under 2 years require diluted concentrations (0.5 mEq/mL or 4.2%) rather than standard adult formulations 2
Critical Safety Warnings
- Do not exceed the recommended maximum daily dose - exceeding 6 mEq/kg total can cause hypernatremia, fluid overload, metabolic alkalosis, and cerebral edema 3
- Monitor for sodium and fluid overload, particularly in patients with heart failure, renal impairment, or hypertension 2
- Excessive bicarbonate can cause hypokalemia and hypocalcemia, potentially leading to cardiac arrhythmias 2, 3
Contraindications
- Avoid in patients with metabolic or respiratory alkalosis 2
- Do not use in patients with hypernatremia or significant sodium retention 2
- Contraindicated when adequate ventilation cannot be maintained, as bicarbonate produces CO2 that must be eliminated 2
Alternative Oral Formulations for Chronic Use
- For chronic kidney disease patients requiring long-term therapy, oral sodium bicarbonate 2-4 g/day (25-50 mEq/day) effectively maintains serum bicarbonate ≥22 mmol/L 2
- Grocery store baking soda (Arm & Hammer) dissolved in water provides a safe, economical alternative to pharmacy-prepared solutions for chronic metabolic acidosis, at approximately 3% of the cost 4
- Standard dosing of 4 g orally three times daily (12 g total) achieves effective urine alkalinization within 10-20 hours in healthy volunteers 5
Monitoring Requirements
- Check serum electrolytes (sodium, potassium, calcium) if using maximum doses or in high-risk patients 2, 3
- Monitor for signs of fluid overload, particularly peripheral edema and dyspnea 2
- Assess for symptoms of alkalosis including muscle twitching, irritability, and tetany 2
Common Pitfalls to Avoid
- Never mix with calcium-containing solutions or medications - precipitation will occur 2
- Do not administer simultaneously with vasoactive amines (epinephrine, norepinephrine) as bicarbonate inactivates these medications 2
- Avoid using for routine treatment of lactic acidosis when pH ≥7.15, as evidence shows no benefit and potential harm 2
- Do not rely solely on bicarbonate without addressing the underlying cause of acidosis 2