Finally, we will discuss the place of sodium bicarbonate in the management of toxic alcohol ingestions. Fourth, the data on the role of sodium bicarbonate in the management of salicylate poisoning will be provided. Third, we will review the literature on the role of sodium bicarbonate in the management of sodium channel blocker toxicities.
Second, we will discuss the mechanism of action, potential side effects, and typical dosing of sodium bicarbonate. We will first briefly review the mechanisms of metabolic acidosis related biochemical derangements since some of the overdoses are associated with metabolic acidosis. The goal of this article is to review the data and evidence on the use of sodium bicarbonate in the management of some pharmacological overdoses. However, in some cases, these medications may result in harm including a severe illness and death due to intentional or unintentional overdose or as a result of idiosyncratic drug reaction. In the vast majority of cases the use of such prescribed medications provides clinical benefit to patients. In the USA, at least 34% of the population regularly takes at least one prescription medication.
Patients with oliguric/anuric renal failure and advanced decompensated heart failure should not receive sodium bicarbonate. While receiving sodium bicarbonate, patients must be monitored for the development of associated side effects including electrolyte abnormalities, the progression of metabolic alkalosis, volume overload, worsening respiratory status, and/or worsening metabolic acidosis. The potential mechanisms of sodium bicarbonate include high sodium load and the development of metabolic alkalosis with resultant decreased tissue penetration of the toxic substance with subsequent increased urinary excretion. However, most of the available evidence originates from case reports, case series, and expert consensus recommendations. Based on the available literature and empiric experience, the administration of sodium bicarbonate appears to be beneficial in the management of a patient with the above-mentioned toxidromes. In this article, we review the data regarding the impact of systemic sodium bicarbonate administration in the management of certain poisonings including sodium channel blocker toxicities, salicylate overdose, and ingestion of some toxic alcohols and in various pharmacological toxicities. According to the Center for Disease Control, in 2013, at least 2113 human fatalities attributed to poisonings occurred in the United States of America.
Adverse reactions to commonly prescribed medications and to substances of abuse may result in severe toxicity associated with increased morbidity and mortality.
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