Bicarbonate Supplementation

Aka: Bicarbonate Supplementation, Polycitra, Shohl Solution, Oral Sodium Bicarbonate, Baking Soda

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II. Indications

  1. Renal Tubular Acidosis

III. Medications: Oral Preparations for Renal Tubular Acidosis

  1. Potassium Citrate (Polycitra)
    1. Concentration: 500 mg per 5 ml
    2. Base Concentration: 2 meq per 1 ml
  2. Oral Sodium Bicarbonate (325 mg and 650 mg tablets)
    1. Base Concentration: 4 meq per 325 mg tablet
  3. Citric Acid (Shohl Solution)
    1. Concentration: 140 grams per 1000 ml
    2. Base concentration: 1 meq per 1 ml

IV. Medications: Baking Soda

  1. Indications: Other household uses
    1. Baking Products
    2. Deodorant
    3. Household cleaner
    4. Mouthwash
  2. Contents
    1. Sodium (42 mEq/tsp)
    2. Bicarbonate (42 mEq/tsp)
  3. Dosing: Antacid in Adults
    1. Home Remedy (other products are preferred as Antacids)
    2. Dose: 1 to 2.5 teaspoons (42 to 105 mEq each of Sodium and bicarbonate) per dose
    3. Maximum: Up to 5 teaspoons/day (210 mEq/day each of Sodium and bicarbonate)
  4. Adverse Effects: Toxicity
    1. Risk of life threatening adverse effects
      1. Highest risk in age <6 years (esp. infants)
      2. May occur in adults with >5 tsp per day
    2. Hypernatremia
    3. Metabolic Alkalosis
  5. References
    1. Capobianco, Young-Rizk, Stem and Zivick (2023) Crit Dec Emerg Med 37(12): 14-5
    2. Nichols (1995) Pediatr Emerg Care 11(2): 109-11 [PubMed]

V. Dosing: Oral Dosing in Renal Tubular Acidosis

  1. Distal RTA (low dose): 1-2 meq/kg/day
  2. Proximal RTA (high dose): 10-15 meq/kg/day

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