MDElliottMD: home-claude house-rule fix (terminology / spelling)

2026-05-23T04:44:07Z

home-claude house-rule fix (terminology / spelling)

← Older revision		Revision as of 04:44, 23 May 2026
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	\| pregnancy = Routine antacid and acidosis correction acceptable		\| pregnancy = Routine antacid and acidosis correction acceptable
	\| legal = [[USLegal:Prescription only\|Rx-only]] for IV formulations; OTC for oral		\| legal = [[USLegal:Prescription only\|Rx-only]] for IV formulations; OTC for oral
	\| mechanism = <vote slug="nahco3-mech-claim">Sodium bicarbonate raises serum pH directly via the carbonic acid / bicarbonate buffer system; in TCA overdose its benefit is partly pH-driven (reducing free ~~drug~~) and partly sodium-driven (overcoming TCA sodium-channel blockade), which is why hypertonic 8.4% is preferred over isotonic.</vote> Bicarbonate is not benign: high-volume use produces hypernatremia, metabolic alkalosis, hypokalemia, and (in arrest) paradoxical intracellular acidosis<ref name="nahco3-label" />.		\| mechanism = <vote slug="nahco3-mech-claim">Sodium bicarbonate raises serum pH directly via the carbonic acid / bicarbonate buffer system; in TCA overdose its benefit is partly pH-driven (reducing the free unbound fraction) and partly sodium-driven (overcoming TCA sodium-channel blockade), which is why hypertonic 8.4% is preferred over isotonic.</vote> Bicarbonate is not benign: high-volume use produces hypernatremia, metabolic alkalosis, hypokalemia, and (in arrest) paradoxical intracellular acidosis<ref name="nahco3-label" />.
	}}		}}

	== References ==		== References ==
	<references />		<references />

MDElliottMD: home-claude punt-list stub-split, Top 300 #227

2026-05-23T04:41:15Z

home-claude punt-list stub-split, Top 300 #227

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Sodium bicarbonate is a systemic alkalinizing agent and antacid, used intravenously in severe metabolic acidosis, hyperkalemia with cardiotoxicity, tricyclic-antidepressant overdose with QRS widening, and (historically) cardiac arrest; orally as an antacid and urinary alkalinizer; and as the carrier base for many effervescent formulations<ref name="nahco3-label">FDA Prescribing Information, Sodium Bicarbonate Injection, Hospira, current revision. https://www.accessdata.fda.gov/drugsatfda_docs/label/2017/018802s022lbl.pdf</ref>. Routine bicarbonate administration in cardiac arrest was removed from ACLS algorithms because it did not improve survival and worsened intracellular acidosis; the remaining strong indications are narrow and physiology-driven.

{{MedTemplate
| generic = Sodium bicarbonate
| brand = Neut, many generic; OTC oral: Alka-Seltzer (with aspirin/citric acid), baking soda
| structure =
| classes = [[:Category:Antacids|Antacid]], [[:Category:Electrolyte_replacements|Electrolyte replacement]]
| uses = <vote slug="severe-metabolic-acidosis-use">Severe metabolic acidosis</vote>, <vote slug="hyperkalemia-cardiotoxicity-use">Hyperkalemia with ECG changes</vote>, <vote slug="tca-overdose-use">Tricyclic-antidepressant overdose with QRS widening</vote>, <vote slug="urinary-alkalinization-use">Urinary alkalinization (salicylate or methotrexate toxicity, uric-acid stones)</vote>, <vote slug="antacid-use">Symptomatic antacid (oral)</vote>
| starting_dose = IV: 1 mEq/kg bolus in arrest indication, then titrated to ABG and clinical status; PO: 325-2000 mg up to QID as antacid
| preparations = 4.2%, 7.5%, 8.4% IV (1 mEq/mL at 8.4%); 325, 650 mg oral tablets; bulk powder
| fda_max = No fixed maximum; titrated to pH and bicarbonate level; chronic high oral doses cause metabolic alkalosis and volume overload
| pill_id =
| routes = IV, oral
| onset = Immediate (IV); within minutes (oral antacid)
| duration = IV: hours, dependent on ongoing acid load; oral antacid: ~30 minutes
| halflife = Not applicable (electrolyte and buffer)
| bioavailability = 100% (IV); rapidly neutralized by gastric acid (oral)
| pregnancy = Routine antacid and acidosis correction acceptable
| legal = [[USLegal:Prescription only|Rx-only]] for IV formulations; OTC for oral
| mechanism = <vote slug="nahco3-mech-claim">Sodium bicarbonate raises serum pH directly via the carbonic acid / bicarbonate buffer system; in TCA overdose its benefit is partly pH-driven (reducing free drug) and partly sodium-driven (overcoming TCA sodium-channel blockade), which is why hypertonic 8.4% is preferred over isotonic.</vote> Bicarbonate is not benign: high-volume use produces hypernatremia, metabolic alkalosis, hypokalemia, and (in arrest) paradoxical intracellular acidosis<ref name="nahco3-label" />.
}}

== References ==
<references />

Sodium Bicarbonate - Revision history

MDElliottMD: home-claude house-rule fix (terminology / spelling)

MDElliottMD: home-claude punt-list stub-split, Top 300 #227