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ACUTE EXPOSURE INFORMATION

  1. USES: Sodium bicarbonate is used to treat metabolic acidosis, hyperkalemia, to treat QRS widening and dysrhythmias resulting from drugs that cause sodium channel blockade, to prevent contrast-induce nephropathy, and to alkalinize the urine. It is also present in antacids, mouthwash and baking soda. It is also an additive in meat processing and used to clean and neutralize acidity in vegetables.
  1. PHARMACOLOGY: Sodium bicarbonate dissociates to provide bicarbonate ions. Bicarbonate neutralizes hydrogen ion concentration and raises blood and urinary pH. Dissociated sodium ions help to overcome sodium channel blockade from certain sodium channel blocking drugs.
  1. TOXICOLOGY: Toxic effects from sodium bicarbonate are secondary to the sodium and bicarbonate ions which causes hypernatremia, alkalosis, and other secondary effects.
  1. EPIDEMIOLOGY: Sodium bicarbonate is extremely common in the environment and potential exposures are very common but rarely serious. Indeed, it is given as a treatment for many seriously ill patients. However, fatalities, though very rare, can occur with exposures, especially in small children.
  1. WITH THERAPEUTIC USE
    1. ADVERSE EFFECTS: Adverse events include gastrointestinal symptoms such as nausea, vomiting, belching, and flatulence from oral exposures and mild electrolyte abnormalities (hypokalemia, hypocalcemia, hypernatremia) and metabolic alkalosis.
  1. WITH POISONING/EXPOSURE
    1. MILD TO MODERATE TOXICITY: Gastrointestinal symptoms are common, including nausea, vomiting, belching, flatulence, and gastric distention. Mild metabolic effects are possible, including alkalosis, hypocalcemia, hypokalemia and hypernatremia with associated dizziness, weakness, and irritability.
    1. SEVERE TOXICITY: Severe alkalemia may result in impaired oxygen release from hemoglobin, hypocalcemia tetany, paradoxical intracellular acidosis (from elevated pCO2), and hypokalemia. Hypernatremia and hyperosmolality can cause seizures and coma. Excessive sodium bicarbonate may also cause congestive heart failure exacerbation and pulmonary edema. Electrolyte abnormalities secondary to sodium bicarbonate administration may lead to QT prolongation and cardiac dysrhythmias. Severe gastric distention can rarely lead to stomach rupture with severe abdominal pain and hematemesis. Parenteral sodium bicarbonate extravasation may lead to tissue inflammation and necrosis. Inhalational exposures may cause pulmonary irritation, especially if exposed to higher concentrations as in some fire extinguishers. Dermal and eye exposures may cause some mild irritation.
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