CT of the chest, abdomen, and pelvis was significant only for diffuse mild dilation of the small bowel and marked fluid content of the entire GI tract. While in the ED, the patient received 2L normal saline and intravenous potassium replacement. Neurosurgery was consulted but did not recommend any surgical intervention. He was admitted to the intensive care unit where he continued to receive IV normal saline and electrolyte repletion. His estimated sodium burden was 5,mEq. A repeat head CT showed stable intracranial hemorrhages.
He denied suicidal ideation and after evaluation, psychiatry deemed the patient safe for discharge. He was discharged on hospital day 4 at which time he had a non-focal neurologic exam. Baking soda toxicity causes hypernatremic metabolic alkalosis with associated hypochloremia, hypokalemia and urinary alkalization, all of which were present in our patient. Increased serum bicarbonate following ingestion results in increased renal excretion, known as bicarbonate diuresis. However, in large ingestions there can be substantial free water loss, resulting in an impaired glomerular filtration rate GFR and ultimately reduced bicarbonate filtering.
Central nervous system CNS hypernatremia causes an osmotic shift of water out of neurons, cellular dehydration and neuronal cell shrinkage. Cerebral volume loss causes retraction of tissues within the skull. Increased tension on dural bridging veins results in rupture of vascular structures and ultimately intracranial hemorrhage, most often in the subdural space.
Certain populations are at greater risk of complications associated with baking soda misuse, including alcoholics due to volume depletion associated with poor oral intake chronic vomiting , the elderly, hypovolemic patients, and patients with underlying pulmonary or renal disease. Published cases of baking soda toxicity frequently involve its excessive use as an antacid.
Baking soda toxicity can present in numerous ways. Published reports of hypernatremia as a cause of cerebral hemorrhage are rare. We could not find any cases of baking soda ingestion resulting in cerebral hemorrhage and hypernatremia. Laboratory evaluation for suspected baking soda ingestion should include a complete metabolic panel, arterial blood gas and EKG.
Metabolic alkalosis, if severe, can lead to compensatory hypoventilation and hypercapnia, which was seen with our patient. Severe metabolic alkalosis is associated with a leftward shift of the oxygen-hemoglobin dissociation curve, resulting in impaired oxygen delivery to tissue and hypoxemia. Cardiopulmonary arrest and death from hypercapnic respiratory failure in the setting of metabolic alkalosis has been reported.
Hypokalemia can result in a prolonged QT interval and subsequent ventricular arrhythmias. Treatment of toxic baking soda ingestions includes intravenous fluid resuscitation and potassium supplementation. Most cases of metabolic alkalosis will resolve with volume resuscitation. The first step is to calculate the free water deficit.
The correction factor is 0. Dialysis can also be considered. In subacute settings occurring over 1—2 days correction can occur between 0. Large potassium deficits are typically present with baking soda toxicity and should be aggressively monitored and replaced.
Hemodialysis can be considered in critically ill patients with renal failure and severe electrolyte derangements that are not responding to fluid and electrolyte repletion. In the setting of ventricular dysrhythmias, electrolytes should be corrected.
Amiodarone and lidocaine are first line for treatment of ventricular tachycardia.. Seizures should be treated with benzodiazepines. In summary, we present a case of a baking soda overdose resulting in hemorrhagic encephalopathy, metabolic alkalosis and hypernatremia. Baking soda can lead to life-threatening complications when misused. Healthcare providers should be aware of the common practice of using baking soda as a home remedy for indigestion and the potential dangers associated with its misuse.
The combination of hypernatremia and metabolic alkalosis should raise suspicion for ingestion of baking soda. Although rare, severe acute hypernatremia can result in intracranial hemorrhage due to CNS dehydration and stretching of vascular structures within the skull. Section Editor: Rick A.
McPheeters, DO. Conflicts of Interest: By the West JEM article submission agreement, all authors are required to disclose all affiliations, funding sources and financial or management relationships that could be perceived as potential sources of bias.
The authors disclosed none. National Center for Biotechnology Information , U. West J Emerg Med. Published online Jul Do not use this product if you are on a sodium-restricted diet unless directed by a doctor.
Do not take more than 24 tablets for adults up to 60 years of age or 12 tablets for adults 60 years of age and older in a hour period nor use the maximum dosage for more than 2 weeks, except under the advice and supervision of a physician.
As with any drug, if you are pregnant or nursing a baby, seek advise of a health professional before using this product. Consult a doctor if severe stomach pain occurs after taking this product. Antacids may interact with certain prescription drugs. If you are presently taking a prescription drug, do not take this product without checking with your physician or other health professional.
In case of accidental overdose, seek professional assistance or contact a poison control center immediately. It is important to keep all medication out of sight and reach of children as many containers such as weekly pill minders and those for eye drops, creams, patches, and inhalers are not child-resistant and young children can open them easily.
To protect young children from poisoning, always lock safety caps and immediately place the medication in a safe location — one that is up and away and out of their sight and reach.
In case of overdose, call the poison control helpline at If the victim has collapsed, had a seizure, has trouble breathing, or can't be awakened, immediately call emergency services at If your doctor has prescribed sodium bicarbonate, keep all scheduled appointments so that your response to the medicine can be checked. It is important for you to keep a written list of all of the prescription and nonprescription over-the-counter medicines you are taking, as well as any products such as vitamins, minerals, or other dietary supplements.
You should bring this list with you each time you visit a doctor or if you are admitted to a hospital. It is also important information to carry with you in case of emergencies. Sodium Bicarbonate pronounced as soe' dee um bye kar' bon ate. Why is this medication prescribed? How should this medicine be used? What special precautions should I follow? What special dietary instructions should I follow?
What should I do if I forget a dose? What side effects can this medication cause? What should I know about storage and disposal of this medication? Brand names Brand names of combination products Other names.
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