Sodium Bicarbonate-D5w

Drug overview for SODIUM BICARBONATE-D5W (sodium bicarbonate in dextrose 5%-water):

Generic name: SODIUM BICARBONATE IN DEXTROSE 5%-WATER
Drug class: Bicarbonates
Therapeutic class: Electrolyte Balance-Nutritional Products

Sodium bicarbonate is an alkalinizing agent.

Sodium bicarbonate is used parenterally as an alkalinizing agent in the treatment of metabolic acidosis, which may occur in severe renal disease, uncontrolled diabetes, circulatory insufficiency due to shock or severe dehydration, extracorporeal circulation of blood, cardiac arrest, and severe primary lactic acidosis. Sodium bicarbonate is also used parenterally for the treatment of certain drug intoxications, including barbiturates, salicylate or methyl alcohol poisoning, and in the treatment of hemolytic reactions requiring alkalinization of the urine to diminish the nephrotoxic effects of blood pigments. In addition, sodium bicarbonate is used parenterally in the treatment of severe diarrhea accompanied by substantial GI bicarbonate loss.

Sodium bicarbonate is available in various over-the-counter (OTC) oral preparations including a preparation of sodium bicarbonate in fixed combination with aspirin and citric acid; these preparations are used for the treatment of heartburn or dyspepsia. Sodium bicarbonate is also available in fixed combination with omeprazole for oral use; see the prescribing information for specific indications and other information regarding combination products.

DRUG IMAGES

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The following indications for SODIUM BICARBONATE-D5W (sodium bicarbonate in dextrose 5%-water) have been approved by the FDA:

Indications:
None.

Professional Synonyms:
None.

The following dosing information is available for SODIUM BICARBONATE-D5W (sodium bicarbonate in dextrose 5%-water):

Dosing
Administration
Dosing Information
Generic

Sodium bicarbonate 42 mg is equal to 0.5 mEq each of sodium (Na+) and bicarbonate (HCO3-). Sodium bicarbonate 75 mg is equal to 0.892

mEq each of Na+ and HCO3-. Sodium bicarbonate 84 mg is equal to 1 mEq each of Na+ and HCO3-.

Dosage of sodium bicarbonate injection is determined by severity of the acidosis, appropriate laboratory determinations, and the patient's age, weight, and clinical condition. Frequent laboratory determinations and clinical evaluation of the patient are essential during therapy with sodium bicarbonate, especially during prolonged therapy, to monitor changes in fluid and electrolyte and acid-base balance.

Generally, full correction of bicarbonate deficit should not be attempted during the first 24 hours of sodium bicarbonate therapy, since this may result in precipitation of metabolic alkalosis because of delayed physiologic compensatory mechanisms. Due to this delay, reaching a total CO2 content of approximately 20 mEq/liter by the end of the first day of treatment is typically linked to a normal blood pH. Further correction of the acidosis to fully normal levels usually happens if the kidney function is normal and if and when the underlying cause of the acidosis can be controlled.

If total CO2 levels are normalized or brought above normal within the first day, this may likely result in an excessively high (alkaline) blood pH, which can lead to undesired side effects.

In cases of metabolic acidosis associated with shock, monitor therapy by assessing blood gases, plasma osmolarity, arterial blood lactate, hemodynamic status, and cardiac rhythm. Bicarbonate therapy should always be administered gradually and in stages since the degree of response from a specific dose is not precisely predictable.

No enhanced Administration information available for this drug.

No dosing information available.

No generic dosing information available.

The following drug interaction information is available for SODIUM BICARBONATE-D5W (sodium bicarbonate in dextrose 5%-water):

Contraindicated
Severe
Moderate

There are 0 contraindications.

There are 2 severe interactions. These drug interactions can produce serious consequences in most patients. Actions required for severe interactions include, but are not limited to, discontinuing one or both agents, adjusting dosage, altering administration scheduling, and providing additional patient monitoring. Review the full interaction monograph for more information.

Drug Interaction	Drug Names
Methenamine/Urinary Alkalinizers SEVERITY LEVEL: 2-Severe Interaction: Action is required to reduce the risk of severe adverse interaction. MECHANISM OF ACTION: Urinary alkalinizers may elevate urinary ph preventing the conversion of methenamine to formaldehyde and mandelic acid.(1) CLINICAL EFFECTS: Concurrent administration may result in alkalinization of the urine causing methenamine to be less effective.(1) PREDISPOSING FACTORS: None determined. PATIENT MANAGEMENT: The Australian and UK manufacturers of methenamine state that concurrent use with agents that make urine alkaline or urine alkalinizing agents should be avoided.(2,3) Patients receiving concurrent therapy should be monitored for urinary ph and any worsening symptoms of their infection, including dysuria, flank pain, or fever.(1) DISCUSSION: Administration of urinary alkalinizers may result in alkalinization of the urine resulting in therapeutic failure of methenamine. Formaldehyde is released by acid hydrolysis from methenamine resulting in bactericidal concentrations at urinary ph 5.0 to 5.5. Above urinary ph 6.0 there is insufficient quantities of formaldehyde and methenamine released to achieve a therapeutic response.(1) An in vitro study showed that methenamine efficacy is achieved when the urine pH is less than 5.7 to 5.85.(4)	MB CAPS, ME-NAPHOS-MB-HYO 1, METHENAMINE, METHENAMINE HIPPURATE, METHENAMINE MANDELATE, URELLE, URETRON D-S, URIBEL TABS, URIMAR-T, URNEVA, URO-MP, URO-SP, UROGESIC-BLUE, UROQID-ACID NO.2, URYL
Dextroamphetamine Transdermal/Urinary Alkalinizers SEVERITY LEVEL: 2-Severe Interaction: Action is required to reduce the risk of severe adverse interaction. MECHANISM OF ACTION: Urinary alkalinizers decrease the renal elimination of dextroamphetamine.(1) CLINICAL EFFECTS: Concurrent use of dextroamphetamine and urinary alkalinizers may result in increased dextroamphetamine levels and side effects. PREDISPOSING FACTORS: None determined. PATIENT MANAGEMENT: Coadministration of dextroamphetamine with urinary alkalinizing agents should be avoided.(1) DISCUSSION: Concurrent use of alkalinizing agents with dextroamphetamine decreases the renal elimination of dextroamphetamine. Co-administration of these should be avoided because of the potential of increased actions of dextroamphetamine.(1)	XELSTRYM

Drug Interaction

Drug Names

Methenamine/Urinary Alkalinizers

SEVERITY LEVEL: 2-Severe Interaction: Action is required to reduce the risk of severe adverse interaction.

MECHANISM OF ACTION: Urinary alkalinizers may elevate urinary ph preventing the conversion of methenamine to formaldehyde and mandelic acid.(1)

CLINICAL EFFECTS: Concurrent administration may result in alkalinization of the urine causing methenamine to be less effective.(1)

PREDISPOSING FACTORS: None determined.

PATIENT MANAGEMENT: The Australian and UK manufacturers of methenamine state that concurrent use with agents that make urine alkaline or urine alkalinizing agents should be avoided.(2,3) Patients receiving concurrent therapy should be monitored for urinary ph and any worsening symptoms of their infection, including dysuria, flank pain, or fever.(1)

DISCUSSION: Administration of urinary alkalinizers may result in alkalinization of the urine resulting in therapeutic failure of methenamine. Formaldehyde is released by acid hydrolysis from methenamine resulting in bactericidal concentrations at urinary ph 5.0 to 5.5.

Above urinary ph 6.0 there is insufficient quantities of formaldehyde and methenamine released to achieve a therapeutic response.(1) An in vitro study showed that methenamine efficacy is achieved when the urine pH is less than 5.7

to 5.85.(4)

MB CAPS, ME-NAPHOS-MB-HYO 1, METHENAMINE, METHENAMINE HIPPURATE, METHENAMINE MANDELATE, URELLE, URETRON D-S, URIBEL TABS, URIMAR-T, URNEVA, URO-MP, URO-SP, UROGESIC-BLUE, UROQID-ACID NO.2, URYL

Dextroamphetamine Transdermal/Urinary Alkalinizers

SEVERITY LEVEL: 2-Severe Interaction: Action is required to reduce the risk of severe adverse interaction.

MECHANISM OF ACTION: Urinary alkalinizers decrease the renal elimination of dextroamphetamine.(1)

CLINICAL EFFECTS: Concurrent use of dextroamphetamine and urinary alkalinizers may result in increased dextroamphetamine levels and side effects.

PREDISPOSING FACTORS: None determined.

PATIENT MANAGEMENT: Coadministration of dextroamphetamine with urinary alkalinizing agents should be avoided.(1)

DISCUSSION: Concurrent use of alkalinizing agents with dextroamphetamine decreases the renal elimination of dextroamphetamine. Co-administration of these should be avoided because of the potential of increased actions of dextroamphetamine.(1)

XELSTRYM

There are 3 moderate interactions. The clinician should assess the patient’s characteristics and take action as needed. Actions required for moderate interactions include, but are not limited to, discontinuing one or both agents, adjusting dosage, altering administration.

Drug Interaction	Drug Names
Sympathomimetics/Urinary Alkalinizers SEVERITY LEVEL: 3-Moderate Interaction: Assess the risk to the patient and take action as needed. MECHANISM OF ACTION: Unionized sympathomimetic amines will be reabsorbed into systemic circulation from the distal tubules of the kidneys. CLINICAL EFFECTS: Enhanced sympathomimetic activity and increased risk of sympathomimetic toxicity. PREDISPOSING FACTORS: None determined. PATIENT MANAGEMENT: Watch patient for enhanced sympathomimetic side effects when urinary alkalinizers are concomitantly used. A lower dose of certain sympathomimetics may be required. DISCUSSION: Signs and symptoms of sympathomimetic toxicity include euphoria, confusion, delirium, hallucinations and nervousness.	AKOVAZ, BENZPHETAMINE HCL, EMERPHED, EPHEDRINE HCL, EPHEDRINE SULFATE, EPHEDRINE SULFATE-0.9% NACL, EPHEDRINE SULFATE-NACL, LISDEXAMFETAMINE DIMESYLATE, MIDODRINE HCL, REZIPRES, VYVANSE
Quinidine/Urinary Alkalinizers SEVERITY LEVEL: 3-Moderate Interaction: Assess the risk to the patient and take action as needed. MECHANISM OF ACTION: Quinidine elimination is impaired by urinary alkalinization. CLINICAL EFFECTS: Potentiation of quinidine effects may be observed. PREDISPOSING FACTORS: None determined. PATIENT MANAGEMENT: Monitoring quinidine levels and cardiac function may be indicated. The quinidine dose may need to be adjusted when a urinary alkalinizer is started or stopped. DISCUSSION: Additional documentation is necessary to confirm this potential interaction.	NUEDEXTA, QUINIDINE GLUCONATE, QUINIDINE SULFATE
Memantine; Amantadine/Urinary Alkalinizers SEVERITY LEVEL: 3-Moderate Interaction: Assess the risk to the patient and take action as needed. MECHANISM OF ACTION: Memantine and amantadine elimination is impaired by urinary alkalinization.(1,2) CLINICAL EFFECTS: Potentiation of memantine or amantadine effects may be observed. PREDISPOSING FACTORS: None determined. PATIENT MANAGEMENT: Monitor patient for adverse reactions such as dizziness, headache, or confusion if a urinary alkalinizer is required. The memantine or amantadine dose may need to be adjusted when a urinary alkalinizer is started or stopped.(1,2) DISCUSSION: The clearance of memantine was reduced by about 80% under alkaline urine conditions at pH 8. Urine alkalinization may lead to an accumulation of memantine with a possible increase in adverse effects. Urine pH is also altered by diet and clinical state of the patient (e.g., renal tubular acidosis or severe infections of the urinary tract). Hence, memantine should be used with caution under these conditions.(1) A study in rats showed that concomitant administration of sodium bicarbonate with amantadine caused a decrease in amantadine renal clearance (1.16 vs. 0.76). Amantadine's area-under-the-curve (AUC) was increased approximately 78%.(3) A study in 12 healthy subjects showed that plasma concentrations of memantine are dependent on urine pH. Alkaline urine pH caused a 79% reduction in renal clearance.(4)	AMANTADINE, AMANTADINE HCL, GOCOVRI, MEMANTINE HCL, MEMANTINE HCL ER, MEMANTINE HCL-DONEPEZIL HCL ER, NAMENDA XR, NAMZARIC, OSMOLEX ER

The following contraindication information is available for SODIUM BICARBONATE-D5W (sodium bicarbonate in dextrose 5%-water):

Overview
Contraindicated
Severe
Moderate

Drug contraindication overview.

*Patients with excessive chloride loss from vomiting or continuous GI suctioning. *Patients at risk of developing diuretic-induced hypochloremic alkalosis.

There are 2 contraindications. Absolute contraindication.

Contraindication List
Hypochloremia
Metabolic alkalosis

There are 6 severe contraindications. Adequate patient monitoring is recommended for safer drug use.

Severe List
Anuria
Chronic heart failure
Edema
Hypocalcemia
Hypokalemia
Severe renal impairment

There are 1 moderate contraindications. Clinically significant contraindication, where the condition can be managed or treated before the drug may be given safely.

Moderate List
Oliguria

The following adverse reaction information is available for SODIUM BICARBONATE-D5W (sodium bicarbonate in dextrose 5%-water):

Overview
Severe
Less Severe

Adverse reaction overview.

Adverse effects from IV sodium bicarbonate treatment include manifestations of metabolic alkalosis (muscular twitching, irritability, and tetany); hypernatremia; and chemical cellulitis with tissue necrosis, ulceration or sloughing at the site of infiltration from extravasation.

There are 3 severe adverse reactions.

More Frequent	Less Frequent
None.	None.

Rare/Very Rare
Hypocalcemia Hypokalemia Metabolic alkalosis

There are 2 less severe adverse reactions.

More Frequent	Less Frequent
None.	None.

Rare/Very Rare
Cellulitis Edema

The following precautions are available for SODIUM BICARBONATE-D5W (sodium bicarbonate in dextrose 5%-water):

Pediatric
Pregnant
Lactation
Geriatric

Rapid injection (10 mL/minute) of hypertonic sodium bicarbonate solutions in neonates and children younger than 2 years of age may produce hypernatremia, decreased CSF pressure, and possible intracranial hemorrhage. It is recommended that the rate of IV administration in these children not exceed 8 mEq/kg daily and that slow IV administration of a 4.2% solution may be preferred. In emergencies such as cardiac arrest, the risk of rapid infusion of the drug in these children must be weighed against the potential for death from acidosis.

Contraindicated

None

Severe Precaution

None

Management or Monitoring Precaution

None

Animal reproduction studies have not been performed with sodium bicarbonate. It is also not known whether sodium bicarbonate can cause fetal harm when administered to pregnant women. Sodium bicarbonate should be used during pregnancy only when clearly needed.

The manufacturer provides no specific information for use of sodium bicarbonate during breast-feeding.

Clinical studies of sodium bicarbonate did not include sufficient numbers of patients >=65 years of age to determine whether they respond differently from younger subjects. Other reported clinical experience has not identified differences in responses between geriatric and younger patients. In general, dosage selection for geriatric patients should be cautious, usually starting at the low end of the dosing range, reflecting the higher incidence of decreased hepatic, renal, or cardiac function and of concomitant disease or other drug therapy.