SODIUM BICARBONATE
HAZARDTEXT ®
Information to help in the initial response for evaluating chemical incidents
-IDENTIFICATION
SYNONYMS
SODIUM BICARBONATE SODIUM BICARBONATE (1:1) BAKING SODA BICARBONATE of SODA CARBONIC ACID MONOSODIUM SALT COL-EVAC JUSONIN MEYLON MONOSODIUM CARBONATE MONOSODIUM HYDROGEN CARBONATE NEUT SEL DE VICHY SODA SODA MINT SODIUM ACID CARBONATE SODIUM HYDROGEN CARBONATE SOLUDAL
IDENTIFIERS
USES/FORMS/SOURCES
Sodium bicarbonate is also added to mouthwashes and dentifrices to prevent dental caries. It is employed as an additive in meat processing and used to clean and neutralize acidity in vegetables (HSDB , 2002). Sodium bicarbonate may be an ingredient of folk remedies containing turpentine, castor oil, lemon and sugar.
Sodium bicarbonate is the main (if not only) constituent of most baking sodas, and may be an ingredient of folk remedies containing turpentine, castor oil, lemon and sugar. Poisonings have occurred in infants where sodium bicarbonate was inadvertently substituted for powdered infant formula (DelBeccaro & (Robertson, 1988) Robertson, 1988).
-CLINICAL EFFECTS
GENERAL CLINICAL EFFECTS
- USES: Sodium bicarbonate is used to treat metabolic acidosis, hyperkalemia, to treat QRS widening and dysrhythmias resulting from drugs that cause sodium channel blockade, to prevent contrast-induce nephropathy, and to alkalinize the urine. It is also present in antacids, mouthwash and baking soda. It is also an additive in meat processing and used to clean and neutralize acidity in vegetables.
- PHARMACOLOGY: Sodium bicarbonate dissociates to provide bicarbonate ions. Bicarbonate neutralizes hydrogen ion concentration and raises blood and urinary pH. Dissociated sodium ions help to overcome sodium channel blockade from certain sodium channel blocking drugs.
- TOXICOLOGY: Toxic effects from sodium bicarbonate are secondary to the sodium and bicarbonate ions which causes hypernatremia, alkalosis, and other secondary effects.
- EPIDEMIOLOGY: Sodium bicarbonate is extremely common in the environment and potential exposures are very common but rarely serious. Indeed, it is given as a treatment for many seriously ill patients. However, fatalities, though very rare, can occur with exposures, especially in small children.
MILD TO MODERATE TOXICITY: Gastrointestinal symptoms are common, including nausea, vomiting, belching, flatulence, and gastric distention. Mild metabolic effects are possible, including alkalosis, hypocalcemia, hypokalemia and hypernatremia with associated dizziness, weakness, and irritability. SEVERE TOXICITY: Severe alkalemia may result in impaired oxygen release from hemoglobin, hypocalcemia tetany, paradoxical intracellular acidosis (from elevated pCO2), and hypokalemia. Hypernatremia and hyperosmolality can cause seizures and coma. Excessive sodium bicarbonate may also cause congestive heart failure exacerbation and pulmonary edema. Electrolyte abnormalities secondary to sodium bicarbonate administration may lead to QT prolongation and cardiac dysrhythmias. Severe gastric distention can rarely lead to stomach rupture with severe abdominal pain and hematemesis. Parenteral sodium bicarbonate extravasation may lead to tissue inflammation and necrosis. Inhalational exposures may cause pulmonary irritation, especially if exposed to higher concentrations as in some fire extinguishers. Dermal and eye exposures may cause some mild irritation.
ADVERSE EFFECTS: Adverse events include gastrointestinal symptoms such as nausea, vomiting, belching, and flatulence from oral exposures and mild electrolyte abnormalities (hypokalemia, hypocalcemia, hypernatremia) and metabolic alkalosis.
- Editor's Note: An ERG guide with information appropriate to this material does not exist.
ACUTE CLINICAL EFFECTS
USES: Sodium bicarbonate is used to treat metabolic acidosis, hyperkalemia, to treat QRS widening and dysrhythmias resulting from drugs that cause sodium channel blockade, to prevent contrast-induce nephropathy, and to alkalinize the urine. It is also present in antacids, mouthwash and baking soda. It is also an additive in meat processing and used to clean and neutralize acidity in vegetables. PHARMACOLOGY: Sodium bicarbonate dissociates to provide bicarbonate ions. Bicarbonate neutralizes hydrogen ion concentration and raises blood and urinary pH. Dissociated sodium ions help to overcome sodium channel blockade from certain sodium channel blocking drugs. TOXICOLOGY: Toxic effects from sodium bicarbonate are secondary to the sodium and bicarbonate ions which causes hypernatremia, alkalosis, and other secondary effects. EPIDEMIOLOGY: Sodium bicarbonate is extremely common in the environment and potential exposures are very common but rarely serious. Indeed, it is given as a treatment for many seriously ill patients. However, fatalities, though very rare, can occur with exposures, especially in small children.
Adverse events include the following symptoms: nausea, vomiting, belching, and flatulence from oral exposures and mild electrolyte abnormalities (hypokalemia, hypocalcemia, hypernatremia) and metabolic alkalosis.
MILD TO MODERATE TOXICITY: Gastrointestinal symptoms are common, including nausea, vomiting, belching, flatulence, and gastric distention. Mild metabolic effects are possible, including alkalosis, hypocalcemia, hypokalemia and hypernatremia with associated dizziness, weakness, and irritability. SEVERE TOXICITY: Severe alkalemia may result in impaired oxygen release from hemoglobin, hypocalcemia tetany, paradoxical intracellular acidosis (from elevated pCO2), and hypokalemia. Hypernatremia and hyperosmolality can cause seizures and coma. Excessive sodium bicarbonate may also cause congestive heart failure exacerbation and pulmonary edema. Electrolyte abnormalities secondary to sodium bicarbonate administration may lead to QT prolongation and cardiac dysrhythmias. Severe gastric distention can rarely lead to stomach rupture with severe abdominal pain and hematemesis. Parenteral sodium bicarbonate extravasation may lead to tissue inflammation and necrosis. Inhalational exposures may cause pulmonary irritation, especially if exposed to higher concentrations as in some fire extinguishers. Dermal and eye exposures may cause some mild irritation.
CHRONIC CLINICAL EFFECTS
One case of metabolic alkalosis with myoclonus has been reported from chronic ingestion of approximately 5.8 grams/day of sodium bicarbonate in an antacid preparation (Okada et al, 1996). Presumably, inhalation or ingestion over a long period of time might result in increased serum sodium levels, possibly with increased blood pressure and water retention. SODIUM CHLORIDE, however, may be the only sodium salt with these effects.
-FIRST AID
FIRST AID AND PREHOSPITAL TREATMENT
-RANGE OF TOXICITY
MINIMUM LETHAL EXPOSURE
CASE REPORT: As a rough estimate, a 3-year-old child (with an estimated 10 L extracellular fluid volume) would have to ingest about 4 tablespoonfuls to achieve this level (from 135 to 185 mEq/L). CASE REPORT: However, life-threatening alkalosis has been reported in a 4-month-old child after ingestion of 1 tablespoonful.
MAXIMUM TOLERATED EXPOSURE
Ingestion of 10 to 20 g/kg will produce hypernatremia in the majority of patients. Alkalosis is uncommon unless ingestion is chronic and renal function is impaired: following 25 mEq/kg/day for 3 weeks in adults, plasma CO2 increased by only 5 mEq/L with weight gain as the predominant effect (van Goidsenhoven et al, 1954).
ADULT Alkalosis occurred in 10% of 1350 patients treated with 380 mEq/day in combination with calcium carbonate 640 mEq/day (Kirsner & Palmer, 1942). BICARBONATE: Ingestion of soluble Panadol(R) containing 18 millimoles of bicarbonate per tablet, 8 tablets/day, resulted in hypokalemic metabolic alkalosis in a 29-year-old woman with impaired renal function (Acomb et al, 1987). ANTACID PREPARATION: Severe hypochloremic (chloride 66 mmol/L), hypokalemic (potassium 1.6 mmol/L), metabolic alkalosis (pH 7.54) occurred in a 35-year-old man after ingesting 2L of Gaviscon(R), an antacid preparation, over 48 hours. The patient was admitted with a Glasgow Coma Score of 3/15 and recovered quickly with supportive care (Gawarammana et al, 2007). BAKING SODA: A 65-year-old man developed a mixed acid-base disorder with a pH of 7.69, hypochloremia, hypokalemia and prerenal azotemia following chronic use of baking soda. The patient admitted to daily ingestion of a "palmful" of baking soda and covering a foot ulcer with baking soda and wrapping it in plastic daily for a 1.5 years. He responded to isotonic saline and potassium supplementation for his metabolic alkalosis (primary disorder) (John et al, 2012). BAKING SODA: A 68-year-old man with a history of poorly managed COPD and chronic epigastric pain, developed severe hyponatremia (sodium 121 mEq/L), hypochloremia (chloride 53 mEq/L) hypokalemia (potassium 1.7 mEq/L) and metabolic alkalosis following the chronic use of baking soda. Mechanical ventilation was needed for respiratory failure. He recovered completely following IV fluids and electrolyte replacement and was started on a proton pump inhibitor for an ulcer (Ajbani et al, 2011).
PEDIATRIC INFANT
- Carcinogenicity Ratings for CAS144-55-8 :
ACGIH (American Conference of Governmental Industrial Hygienists, 2010): Not Listed EPA (U.S. Environmental Protection Agency, 2011): Not Listed IARC (International Agency for Research on Cancer (IARC), 2016; International Agency for Research on Cancer, 2015; IARC Working Group on the Evaluation of Carcinogenic Risks to Humans, 2010; IARC Working Group on the Evaluation of Carcinogenic Risks to Humans, 2010a; IARC Working Group on the Evaluation of Carcinogenic Risks to Humans, 2008; IARC Working Group on the Evaluation of Carcinogenic Risks to Humans, 2007; IARC Working Group on the Evaluation of Carcinogenic Risks to Humans, 2006; IARC, 2004): Not Listed NIOSH (National Institute for Occupational Safety and Health, 2007): Not Listed MAK (DFG, 2002): Not Listed NTP (U.S. Department of Health and Human Services, Public Health Service, National Toxicology Project ): Not Listed
TOXICITY AND RISK ASSESSMENT VALUES
- EPA Risk Assessment Values for CAS144-55-8 (U.S. Environmental Protection Agency, 2011):
-STANDARDS AND LABELS
WORKPLACE STANDARDS
- ACGIH TLV Values for CAS144-55-8 (American Conference of Governmental Industrial Hygienists, 2010):
- AIHA WEEL Values for CAS144-55-8 (AIHA, 2006):
- NIOSH REL and IDLH Values for CAS144-55-8 (National Institute for Occupational Safety and Health, 2007):
- OSHA PEL Values for CAS144-55-8 (U.S. Occupational Safety, and Health Administration (OSHA), 2010):
- OSHA List of Highly Hazardous Chemicals, Toxics, and Reactives for CAS144-55-8 (U.S. Occupational Safety and Health Administration, 2010):
ENVIRONMENTAL STANDARDS
- EPA CERCLA, Hazardous Substances and Reportable Quantities for CAS144-55-8 (U.S. Environmental Protection Agency, 2010):
- EPA CERCLA, Hazardous Substances and Reportable Quantities, Radionuclides for CAS144-55-8 (U.S. Environmental Protection Agency, 2010):
- EPA RCRA Hazardous Waste Number for CAS144-55-8 (U.S. Environmental Protection Agency, 2010b):
- EPA SARA Title III, Extremely Hazardous Substance List for CAS144-55-8 (U.S. Environmental Protection Agency, 2010):
- EPA SARA Title III, Community Right-to-Know for CAS144-55-8 (40 CFR 372.65, 2006; 40 CFR 372.28, 2006):
- DOT List of Marine Pollutants for CAS144-55-8 (49 CFR 172.101 - App. B, 2005):
- EPA TSCA Inventory for CAS144-55-8 (EPA, 2005):
LABELS
- NFPA Hazard Ratings for CAS144-55-8 (NFPA, 2002):
-PERSONAL PROTECTION
SUMMARY
- Editor's Note: An ERG guide with information appropriate to this material does not exist.
PROTECTIVE CLOTHING
- CHEMICAL PROTECTIVE CLOTHING. Search results for CAS 144-55-8.
-PHYSICAL HAZARDS
FIRE HAZARD
- FLAMMABILITY CLASSIFICATION
- NFPA Flammability Rating for CAS144-55-8 (NFPA, 2002):
- FIRE CONTROL/EXTINGUISHING AGENTS
- Editor's Note: An ERG guide with information appropriate to this material does not exist.
- NFPA Extinguishing Methods for CAS144-55-8 (NFPA, 2002):
EVACUATION PROCEDURES
- Editor's Note: An ERG guide with information appropriate to this material does not exist.
- AIHA ERPG Values for CAS144-55-8 (AIHA, 2006):
- DOE TEEL Values for CAS144-55-8 (U.S. Department of Energy, Office of Emergency Management, 2010):
Listed as Sodium bicarbonate TEEL-0 (units = mg/m3): 15 TEEL-1 (units = mg/m3): 40 TEEL-2 (units = mg/m3): 300 TEEL-3 (units = mg/m3): 500 Definitions: TEEL-0: The threshold concentration below which most people will experience no adverse health effects. TEEL-1: The airborne concentration (expressed as ppm [parts per million] or mg/m(3) [milligrams per cubic meter]) of a substance above which it is predicted that the general population, including susceptible individuals, could experience notable discomfort, irritation, or certain asymptomatic, nonsensory effects. However, these effects are not disabling and are transient and reversible upon cessation of exposure. TEEL-2: The airborne concentration (expressed as ppm or mg/m(3)) of a substance above which it is predicted that the general population, including susceptible individuals, could experience irreversible or other serious, long-lasting, adverse health effects or an impaired ability to escape. TEEL-3: The airborne concentration (expressed as ppm or mg/m(3)) of a substance above which it is predicted that the general population, including susceptible individuals, could experience life-threatening adverse health effects or death.
- AEGL Values for CAS144-55-8 (National Research Council, 2010; National Research Council, 2009; National Research Council, 2008; National Research Council, 2007; NRC, 2001; NRC, 2002; NRC, 2003; NRC, 2004; NRC, 2004; National Advisory Committee for Acute Exposure Guideline Levels for Hazardous Substances, 2006; National Advisory Committee for Acute Exposure Guideline Levels for Hazardous Substances, 2007; National Advisory Committee for Acute Exposure Guideline Levels for Hazardous Substances, 2005; National Advisory Committee for Acute Exposure Guideline Levels for Hazardous Substances, 2005; National Advisory Committee for Acute Exposure Guideline Levels for Hazardous Substances, 2007; National Advisory Committee for Acute Exposure Guideline Levels for Hazardous Substances, 2006; National Advisory Committee for Acute Exposure Guideline Levels for Hazardous Substances, 2006; National Advisory Committee for Acute Exposure Guideline Levels for Hazardous Substances, 2006; National Advisory Committee for Acute Exposure Guideline Levels for Hazardous Substances, 2006; 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National Advisory Committee for Acute Exposure Guideline Levels for Hazardous Substances, 2009; National Advisory Committee for Acute Exposure Guideline Levels for Hazardous Substances, 2009; National Advisory Committee for Acute Exposure Guideline Levels for Hazardous Substances, 2009; National Advisory Committee for Acute Exposure Guideline Levels for Hazardous Substances, 2009; National Advisory Committee for Acute Exposure Guideline Levels for Hazardous Substances, 2009; National Advisory Committee for Acute Exposure Guideline Levels for Hazardous Substances, 2008; National Advisory Committee for Acute Exposure Guideline Levels for Hazardous Substances, 2008; National Advisory Committee for Acute Exposure Guideline Levels for Hazardous Substances, 2008; National Advisory Committee for Acute Exposure Guideline Levels for Hazardous Substances, 2008; National Advisory Committee for Acute Exposure Guideline Levels for Hazardous Substances, 2008; National Advisory Committee for Acute Exposure Guideline Levels for Hazardous Substances, 2008; National Advisory Committee for Acute Exposure Guideline Levels for Hazardous Substances, 2008; National Advisory Committee for Acute Exposure Guideline Levels for Hazardous Substances, 2009; National Advisory Committee for Acute Exposure Guideline Levels for Hazardous Substances, 2008; National Advisory Committee for Acute Exposure Guideline Levels for Hazardous Substances, 2008; National Advisory Committee for Acute Exposure Guideline Levels for Hazardous Substances, 2008; National Advisory Committee for Acute Exposure Guideline Levels for Hazardous Substances, 2009; National Advisory Committee for Acute Exposure Guideline Levels for Hazardous Substances, 2008; National Advisory Committee for Acute Exposure Guideline Levels for Hazardous Substances, 2008; National Advisory Committee for Acute Exposure Guideline Levels for Hazardous Substances, 2008; National Advisory Committee for Acute Exposure Guideline Levels for Hazardous Substances, 2008; National Advisory Committee for Acute Exposure Guideline Levels for Hazardous Substances, 2008; National Advisory Committee for Acute Exposure Guideline Levels for Hazardous Substances, 2008; National Advisory Committee for Acute Exposure Guideline Levels for Hazardous Substances, 2008; National Advisory Committee for Acute Exposure Guideline Levels for Hazardous Substances, 2007; National Advisory Committee for Acute Exposure Guideline Levels for Hazardous Substances, 2006; National Advisory Committee for Acute Exposure Guideline Levels for Hazardous Substances, 2006; National Advisory Committee for Acute Exposure Guideline Levels for Hazardous Substances, 2006; National Advisory Committee for Acute Exposure Guideline Levels for Hazardous Substances, 2007; National Advisory Committee for Acute Exposure Guideline Levels for Hazardous Substances, 2007; National Advisory Committee for Acute Exposure Guideline Levels for Hazardous Substances, 2007; National Advisory Committee for Acute Exposure Guideline Levels for Hazardous Substances, 2007; National Advisory Committee for Acute Exposure Guideline Levels for Hazardous Substances, 2007; 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62 FR 58840, 1997; 65 FR 14186, 2000; 65 FR 39264, 2000; 65 FR 77866, 2000; 66 FR 21940, 2001; 67 FR 7164, 2002; 68 FR 42710, 2003; 69 FR 54144, 2004):
- NIOSH IDLH Values for CAS144-55-8 (National Institute for Occupational Safety and Health, 2007):
CONTAINMENT/WASTE TREATMENT OPTIONS
-PHYSICAL/CHEMICAL PROPERTIES
MOLECULAR WEIGHT
DESCRIPTION/PHYSICAL STATE
- white crystalline powder or granules (Budavari, 1996)
PH
- 8.3 (for a freshly prepared 0.1 M solution) (Budavari, 1996)
-REFERENCES
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