sodium-bicarbonate and Hypernatremia

Topics: Accidents, Home; Adult; Antidotes; Child, Preschool; Combined Modality Therapy; Emergency Nursing; Emergency Service, Hospital; Female; First Aid; Fluid Therapy; Follow-Up Studies; Humans; Hypernatremia; Male; Risk Assessment; Sodium Bicarbonate; Sodium Chloride; Suicide, Attempted; Survival Rate

Topics: Diagnosis, Differential; Female; Fever; Humans; Hypernatremia; Infant, Newborn; Seizures; Sodium Bicarbonate

We present a case of a six-week-old infant who developed life-threatening complications after unintentional sodium bicarbonate intoxication. Baking soda was being used by the mother as a home remedy to "help the baby burp." A review of the literature regarding the use (or misuse) of baking soda follows. Our patient, along with the other noted case reports, emphasizes the need for warnings on baking soda products whose labels recommend its use as an antacid. Poisonings must be high in the differential diagnosis of any patient, regardless of age, who presents with altered mental status or status epilepticus.

Topics: Drug Labeling; Female; Humans; Hypernatremia; Infant; Infant Care; Medicine, Traditional; Poisoning; Sodium Bicarbonate

Topics: Base Sequence; Dermatologic Agents; Drug Combinations; Humans; Hypernatremia; Ichthyosis; Infant, Newborn; Kallikreins; Netherton Syndrome; Ointments; Proteinase Inhibitory Proteins, Secretory; Sequence Deletion; Serine Peptidase Inhibitor Kazal-Type 5; Sodium Bicarbonate; Zinc Oxide

Topics: Acinetobacter baumannii; Acinetobacter Infections; Blood Loss, Surgical; Fatal Outcome; Female; Humans; Hypernatremia; Intraoperative Complications; Liver Transplantation; Middle Aged; Multiple Organ Failure; Myelinolysis, Central Pontine; Postoperative Complications; Sepsis; Sodium Bicarbonate; Transfusion Reaction

Our objective was to study the risk factors and mechanisms of hypernatraemia in critically ill patients, a common and potentially serious problem.. In 2005, all patients admitted to the medical, surgical or neurological intensive care unit (ICU) of a university hospital were reviewed. A 1:2 matched case-control study was performed, defining cases as patients who developed a serum sodium >/=150 mmol/l in the ICU.. One hundred and thirty cases with ICU-acquired hypernatraemia (141 +/- 3 to 156 +/- 6 mmol/l) were compared to 260 controls. Sepsis (9% versus 2%), hypokalaemia (53% versus 34%), renal dysfunction (53% versus 13%), hypoalbuminaemia (91% versus 55%), the use of mannitol (10% versus 1%) and use of sodium bicarbonate (23% versus 0.4%) were more common in cases (P < 0.05 for all) and were independently associated with hypernatraemia. During the development of hypernatraemia, fluid balance was negative in 80 cases (-31 +/- 2 ml/kg/day), but positive in 50 cases (72 +/- 3 ml/kg/day). Cases with a positive fluid balance received more sodium plus potassium (148 +/- 2 versus 133 +/- 3 mmol/l, P < 0.001). On average, cases were polyuric (40 +/- 5 ml/kg). Mortality was higher in cases (48% versus 10%, P < 0.001), for which hypernatraemia was an independent predictor (odds ratio 4.3, 95% confidence interval 2.5 to 7.2).. Hypernatraemia seems to develop in the ICU because various factors promote renal water loss, which is then corrected with too little water or overcorrected with relatively hypertonic fluids. Therapy should therefore rely on adding electrolyte-free water and/or creating a negative sodium balance. Adjustments in intravenous fluid regimens may prevent hypernatraemia.

Topics: Adult; Aged; Case-Control Studies; Critical Illness; Female; Fluid Therapy; Humans; Hypernatremia; Hypoalbuminemia; Hypokalemia; Intensive Care Units; Kidney Diseases; Male; Mannitol; Middle Aged; Risk Factors; Sepsis; Sodium Bicarbonate; Water-Electrolyte Balance

Five hypernatremic, diarrheic, neonatal calves were treated mainly by the intravenous administration of 5% dextrose alone or with isotonic sodium bicarbonate. All calves recovered without complications. The average reduction rate of serum sodium concentration was about 4 times that recommended and has not been tried successfully before in hypernatremic scouring calves.

Topics: Animals; Animals, Newborn; Cattle; Cattle Diseases; Diarrhea; Female; Glucose; Hypernatremia; Sodium Bicarbonate; Treatment Outcome

To describe changes in blood constituents of horses after oral and i.v. administration of sodium bicarbonate (NaHCO3), and to determine whether the changes are dose dependent.. 6 adult Standardbred mares.. 3 oral doses (1,500, 1,000, and 250 mg/kg of body weight) or 1 intravenous dose (250 mg/kg, 5% solution) of NaHCO3 in 3 L of water, or water (3 L orally), were given to the mares; then changes in blood constituents were measured. Access to food and water was denied during the experiment. Blood samples were collected immediately before treatment and at hourly intervals for 12 hours after treatment, and were analyzed for blood gas tensions; serum osmolality; serum sodium, potassium, chloride, and creatinine concentrations; PCV; and total solids concentration in plasma.. All NaHCO3 treatments induced significant (P < 0.05) metabolic alkalosis, hypernatremia, hypokalemia, and hyperosmolality for at least 8 hours. In mares given the 1,500- and 1,000-mg doses of NaHCO3 orally, hypercapnia persisted for at least 12 hours, whereas hypercapnia lasted 2 hours in mares given the 250-mg dose orally or i.v. (P < 0.05). A tendency for reduction in PCV, proteins in plasma concentration, and serum concentration of chloride was observed 1 hour after i.v. administered doses of NaHCO3.. Oral or i.v. administration of NaHCO3 (> or = 250 mg/kg) to resting horses without ad libitum access to water induces significant and persistent acid-base and electrolyte changes.

Topics: Acid-Base Equilibrium; Administration, Oral; Alkalosis; Animals; Blood Gas Analysis; Blood Proteins; Chlorides; Creatinine; Dose-Response Relationship, Drug; Female; Horses; Hydrogen-Ion Concentration; Hyperkalemia; Hypernatremia; Injections, Intravenous; Osmolar Concentration; Potassium; Sodium; Sodium Bicarbonate; Time Factors

An 11-month-old female Vietnamese pot-bellied pig was examined for severe dehydration and neurologic signs including disorientation, ataxia, blindness, and involuntary twitching of the muscles of the neck and head. Biochemical analyses of serum revealed hypernatremia, hyperchloremia, hyperkalemia, azotemia, hyperphosphatemia, hyperalbuminemia, and high activities of aspartate transaminase and creatine kinase. A diagnosis of salt toxicosis/water deprivation was made. Medical management consisted of intravenous administration of a high-sodium crystalloid solution, anti-inflammatory drugs, and other supportive care. Sodium concentration of fluids administered intravenously was adjusted to be slightly less than the pig's serum sodium concentration so that the serum sodium concentration was reduced gradually over 48 hours. Resolution of clinical signs was rapid and the pig was discharged after 8 days of hospitalization. Fourteen days after the initial examination, the pig appeared healthy except for visual deficits. Historically, prognosis with conventional treatment of salt toxicosis/water deprivation is poor; however, this alternative approach to treating this condition appears promising.

Topics: Animals; Anti-Inflammatory Agents; Brain Edema; Dehydration; Dexamethasone; Dimethyl Sulfoxide; Drug Combinations; Female; Fluid Therapy; Hypernatremia; Infusions, Intravenous; Rehydration Solutions; Sodium; Sodium Bicarbonate; Sodium Chloride; Swine; Swine Diseases; Swine, Miniature; Water Deprivation

Five patients on maintenance haemodialysis were exposed to varying degrees of hypernatric dialysate, leading to acute hypernatraemia (plasma sodium concentrations 158 mmol/l to 179 mmol/l). With the exception of one patient, who developed pulmonary oedema, symptoms were minimal and in each case hypernatraemia was corrected without residual complications. The hypernatric dialysate resulted from a granular and less soluble batch of sodium bicarbonate powder. The extra effort required to dissolve the powder caused CO2 to be shaken out of solution, producing sodium carbonate and raising the pH. Mixing calcium from the 'acid' concentrate with excess carbonate in the 'bicarbonate' concentrate led to rapid precipitation of calcium carbonate on the conductivity monitoring cells. Dialysate conductivity was incorrectly sensed as low by the coated conductivity cells, so that an increasing amount of 'acid' concentrate, with its accompanying electrolytes, was delivered to the patient. When the granular powder was ground to a fine powder, passed through a 125 microns sieve and gently dissolved, the machine operated normally. We recommend that sodium bicarbonate powder is supplied with a sieve size no greater than 125 microns, kept dry to prevent the formation of large crystals, and dissolved gently.

Topics: Acute Disease; Buffers; Calcium Carbonate; Chemical Precipitation; Crystallization; Dialysis Solutions; Female; Humans; Hydrogen-Ion Concentration; Hypernatremia; Male; Particle Size; Renal Dialysis; Sodium Bicarbonate; Solubility

To evaluate the effectiveness of continuous arteriovenous hemodiafiltration (CAVHD) using citrate as the anticoagulant for the treatment of lactic acidosis in patients with renal failure.. Case series with careful monitoring of the clinical course of patients being treated in a medical or surgical ICU.. University hospital ICU.. Two patients with lactic acidosis are described, along with our experience using CAVHD and citrate in other clinical settings.. CAVHD was used to manage renal failure, while a continuous infusion of citrate was administered to maintain patency of the extracorporeal circuit.. Total and ionized serum calcium concentrations and citrate concentrations were monitored.. CAVHD with citrate as the anticoagulant proved to be a convenient means of managing vascular volume, serum electrolyte concentrations, acid-base balance, and replacement renal function requirements in the setting of severe lactic acidosis, oliguric renal failure, and hemorrhagic diathesis.. CAVHD with citrate as the anticoagulant can be recommended as effective therapy for selected patients, but careful monitoring is needed to avoid serious complications.

Topics: Acidosis, Lactic; Adult; Aged; Bicarbonates; Chlorides; Citrates; Citric Acid; Female; Hemofiltration; Humans; Hypernatremia; Kidney Failure, Chronic; Male; Middle Aged; Sodium; Sodium Bicarbonate

Topics: Acute Disease; Adult; Bicarbonates; Female; Humans; Hypernatremia; Sodium; Sodium Bicarbonate; Sodium Chloride

When used appropriately, baking soda (sodium bicarbonate, USP) is a nontoxic, readily available, multipurpose product found in many households. We report an infant who presented with hypernatremia and metabolic alkalosis due to the addition of baking soda to her water. This case represents the possible dangerous use of a common household product in infants owing to the lack of proper warning labels.

Topics: Alkalosis; Bicarbonates; Female; Fluid Therapy; Hospitalization; Humans; Hypernatremia; Infant; Sodium; Sodium Bicarbonate

To examine the effect of selective rise of plasma NaCl concentration (hypernatremia) on NaHCO3 reabsorption and associated NaCl reabsorption remaining during continuous ethacrynic acid infusion, hypertonic NaCl solution was infused in three groups of anesthetized volume-expanded dogs. In six dogs examined at constant hematocrit and plasma pH, bicarbonate and water reabsorptions were inversely related to PNa and reduced by 37% and 39% respectively by raising PNa from 140 to 200 mM. Chloride reabsorption remained essentially constant until PNa exceeded 170 to 180 mM. At PNa 200 mM, sodium reabsorption was reduced by 22 +/- 6%. In six other dogs, mechanical variations of GFR showed that the inhibitory effects of hypernatremia (PNa 199 +/- 3 mM) were less pronounced at low GFR. After subsequent administration of acetazolamide (30 mg/kg body wt), only 20% of control bicarbonate reabsorption remained and glomerulo-tubular balance was completely abolished. Both hypernatremia and acetazolamide inhibited NaHCO3 and NaCl reabsorption in a molar ratio of about 1:2, as in normonatremic dogs. Finally, experiments in six dogs showed that the inhibitory effects of hypernatremia (PNa 213 +/- 4 mM) were not altered by varying PCO2 and plasma pH. We conclude that hypernatremia inhibits paracellular water and NaCl reabsorption in the proximal tubules by reducing the osmotic force caused by transcellular NaHCO3 reabsorption. A rise in PNa does not stimulate transcellular NaCl reabsorption during distal inhibition by ethacrynic acid.

Topics: Acetazolamide; Acid-Base Equilibrium; Animals; Bicarbonates; Carbon Dioxide; Dogs; Ethacrynic Acid; Female; Glomerular Filtration Rate; Hydrogen-Ion Concentration; Hypernatremia; Male; Sodium; Sodium Bicarbonate; Sodium Chloride; Water-Electrolyte Balance

Over a period of 16 months 510 children with diarrhoea were admitted to the Al-Adan Hospital, Kuwait, of whom 26 (5.1%) developed hypernatraemic dehydration. Prominent clinical features included vomiting (92.3%), fever (84.6%) and convulsions (19.2%). The majority were below six months of age with a mean age of 3.1 months. The sex distribution was equal. Twenty infants (77%) had severe metabolic acidosis and were treated with a combination of sodium bicarbonate and 5% glucose in water until the acidosis was corrected after which a solution of sodium chloride replaced the use of sodium bicarbonate. The sodium concentration of the intravenous fluid varied from 15 to 30 mmol/l and was given at a rate of 100 to 120 ml/kg/day. One infant died. The 25 survivors, (96.15%), which included three who developed convulsions during treatment, recovered without any neurologic sequelae.

Topics: Acidosis; Bicarbonates; Dehydration; Female; Fluid Therapy; Glucose; Humans; Hypernatremia; Infant; Infusions, Parenteral; Male; Seizures; Sodium Bicarbonate; Sodium Chloride

Topics: Bicarbonates; Child, Preschool; Female; Humans; Hypernatremia; Self Medication; Sodium; Sodium Bicarbonate

Topics: Administration, Topical; Alkalosis; Bicarbonates; Diaper Rash; Gastroenteritis; Humans; Hypernatremia; Infant; Male; Sodium Bicarbonate

Four cases of the iatrogenic nondiabetic hyperosmolar state are presented. The clinical presentation, biochemical findings and management are discussed. No hypertonic solution should be infused at a rate above the level of patient tolerance; irrigation of a hollow viscus with a hypertonic solution should be avoided, and salt should not be used as an emetic. Patients under stress are particularly prone to this condition, largely because of the high circulating cortisol levels. The use of corticosteroids, salt-containing solutions in excess of patient requirements, water depletion and intravenous nutrition in the absence of careful biochemical monitoring, are all factors which may precipitate the hyperosmolar state in the critically ill.

Topics: Acid-Base Imbalance; Adult; Aged; Bicarbonates; Cerebral Hemorrhage; Citrates; Female; Glucose Solution, Hypertonic; Humans; Hyperglycemia; Hyperglycemic Hyperosmolar Nonketotic Coma; Hypernatremia; Iatrogenic Disease; Male; Middle Aged; Osmolar Concentration; Saline Solution, Hypertonic; Seizures; Sodium Bicarbonate

Topics: Bicarbonates; Child; Child Abuse; Homicide; Humans; Hypernatremia; Male; Sodium; Sodium Bicarbonate; Wisconsin