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Sodium Bicarbonate (NaHCO3)


Indications and Usage


  • Used to alkalinize the urine after uranium intake, which protects the kidneys from uranium deposition.
  • Suggested IV dosing
    • 2 ampoules (44.3 mEq bicarbonate/ampoule) in 1000 cc 5% dextrose in water (D5W) or 0.9% sodium chloride (normal saline, NS) or
    • 250 cc (1-2 mEq/kg) via slow IV infusion
    • Administer therapy until urine pH is 8-9; monitor urine pH hourly
    • Continue Rx for 3 days
  • Suggested PO dosing
    • 2 bicarbonate tablets PO q 4 hr
    • Administer therapy until urine pH is 8-9; monitor urine pH hourly
    • Continue Rx for 3 days
  • For suspected high level uranium intake, consider off-label use of PO diuretics and/or dialysis
    • Etidronate (Didronel) 400 mg PO QD or Diamox 500 mg PO BID.
    • Continue Rx for 3 days.
  • Therapy efficacy and safety can be monitored and guided by
    • Collecting 24-hour urine and fecal specimens and analyzing for uranium content as well as for chemical toxicity (e.g., proteins, microglobulin, casts)
    • Monitoring serum renal function tests

FDA Product Safety Info

  • Not FDA approved for this indication/off-label use
  • WARNING: Pregnancy Category C

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Reference Links


There is minimal actual clinical experience in the treatment of uranium-exposed patients with NaHCO3, but NCRP and some medical experts consider it safe and reasonable1.

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References

  1. Management of Persons Contaminated with Radionuclides: Handbook (NCRP Report No. 161, Vol. I), National Council on Radiation Protection and Measurements, Bethesda, MD, 2008, Medical Treatments Arranged by Radionuclide (pp. 228-233). [Note: NCRP 161 supersedes NCRP 65.]