Warnings and Contraindications

Everything needs to be taken in balance.

Sodium bicarbonate (baking soda) is generally well tolerated. However, high doses may cause headache, nausea or irritability. If any of these effects continue or become bothersome, inform your doctor. Notify your doctor if you develop: muscle weakness, slow reflexes and confusion, swelling of the feet or ankles, black tar-like stools, coffee-ground vomit. If you notice other effects not listed above, contact your doctor or pharmacist.

Do not use if you are on a sodium restricted diet unless directed by a doctor. Ask a doctor or a pharmacist before use if you are taking a prescription drug. Antacids may interact with certain prescription drugs. Do not administer to children under age 5 without careful consideration. To avoid injury do not take sodium bicarbonate until the powder is completely dissolved and it is very important not to take baking soda when overly full from food or drink. Consult a doctor if severe stomach pain occurs after taking this product.

“I nearly died after taking this stuff,” said William Graves, who suffered a rupture through the wall of his stomach in 1979 after taking baking soda mixed in water for indigestion after a big meal. The 64-year-old resident of Bethesda,Md., who is editor of National Geographic Magazine, said that only emergency surgery saved his life and that six more operations were needed to repair the damage. Though there are only a few documented cases users need to know of the dangers.

Adverse reactions to the administration of sodium bicarbonate can include metabolic alkalosis, edema due to sodium overload, congestive heart failure, hyperosmolar syndrome, hypervolemic hypernatremia, and hypertension due to increased sodium. In patients who consume a high calcium or dairy-rich diet, calcium supplements, or calcium-containing antacids such as calcium carbonate (e.g., Tums), the use of sodium bicarbonate can cause milk-alkali syndrome, which can result in metastatic calcification, kidney stones, and kidney failure.

In rare cases, metabolic alkalosis develops in a person who has ingested too much base from substances such as baking soda (bicarbonate of soda).  Severe metabolic alkalosis (ie, blood pH >7.55) is a serious medical problem. Mortality rates have been reported as 45% in patients with an arterial blood pH of 7.55 and 80% when the pH was greater than 7.65.

Administration of sodium bicarbonate in amounts that exceed the capacity of the kidneys to excrete this excess bicarbonate may cause metabolic alkalosis. This capacity is reduced when a reduction in filtered bicarbonate occurs, as observed in renal failure, or when enhanced tubular reabsorption of bicarbonate occurs, as observed in volume depletion.[1]

Metabolic alkalosis is the most common acid-base disturbance observed in hospitalized patients, accounting for approximately 50% of all acid-base disorders.

• Severe alkalosis causes diffuse arteriolar constriction with reduction in tissue perfusion. By decreasing cerebral blood flow, alkalosis may lead to tetany, seizures, and decreased mental status. Metabolic alkalosis also decreases coronary blood flow and predisposes persons to refractory arrhythmias.

• Metabolic alkalosis causes hypoventilation, which may cause hypoxemia, especially in patients with poor respiratory reserve, and it may impair weaning from mechanical ventilation.

• Alkalosis decreases the serum concentration of ionized calcium by increasing calcium ion binding to albumin. In addition, metabolic alkalosis is almost always associated with hypokalemia (low potassium levels), which can cause neuromuscular weakness and arrhythmias, and, by increasing ammonia production, it can precipitate hepatic encephalopathy in susceptible individuals

The physical signs of metabolic alkalosis are not specific and depend on the severity of the alkalosis. Because metabolic alkalosis decreases ionized calcium concentration, signs of hypocalcemia (eg, tetany, Chvostek sign, Trousseau sign), change in mental status, or seizures may be present.

Symptoms of Alkalosis

• Confusion(can progress to stupor or coma)
• Hand tremor
• Light-headedness
• Muscle twitching
• Nausea, vomiting
• Numbness or tingling in the face or extremities
• Prolonged muscle spasms (tetany)

Tell your doctor if you have: pre-existing heart disease, kidney disease, liver disease, high blood pressure, or any allergies. Because this medication contains a large amount of sodium, remind your doctor if you are on a low sodium diet. This medication should be used only if clearly needed during pregnancy. Small amounts of sodium bicarbonate have been found to be present in breast milk.  Discuss the risks and benefits with your doctor even though he or she probably will not be fully aware of the benefits since they have never tried using it as a systemic medicine for chronic diseases like cancer and diabetes.

Tell your doctor of any over-the-counter or prescription medication you may take and ask him about dangers and side effects that are common with such drugs. This medication has the potential to interact with many medications. Do not take any other medication within 1 to 2 hours of taking an antacid. If overdose is suspected, contact your local poison control center or emergency room immediately. US residents can call the US national poison hotline at 1-800-222-1222. Canadian residents should call their local poison control center directly. Symptoms of overdose may include irritability, muscle rigidity, and seizures.

Before taking sodium bicarbonate, tell your doctor if you are taking:

• mecamylamine (Inversine)
• methenamine (Mandelamine)
• ketoconazole (Nizoral)
• antacids
• a tetracycline antibiotic such as tetracycline (Sumycin, Achromycin V, and others), demeclocycline (Declomycin), doxycycline (Vibramycin, Monodox, Doxy, and others), minocycline (Minocin, Dynacin, and others), or oxytetracycline (Terramycin, and others)

You may not be able to take sodium bicarbonate, or you may require a dosage adjustment or special monitoring during treatment if you are taking any of the medicines listed above.

If you miss a dose, take it as soon as remembered; do not take it if it is near the time for the next dose, instead, skip the missed dose and resume your usual dosing schedule. Do not “double-up” the dose to catch up. Store at room temperature between 59 and 86 degrees F (between 15 and 30 degrees C) away from heat, light and moisture.

Make sure you only take a small amount of baking soda solution at any given time, since alkaline substances can neutralize most if not all acids in the stomach, causing the stomach to create more acid. This can, in turn, lead to more heartburn, which will cause you to ingest more baking soda solution and start a dangerous cycle.

Folic acid is needed by the body to utilize Vitamin B12.[2] Antacids, including sodium bicarbonate, inhibit folic acid absorption.1 People taking antacids are advised to supplement with folic acid.