ENTRANCE LIVERSALT (PLAIN)

Indications

• Metabolic acidosis
• Chronic renal failure
• Respiratory acidosis
• Urinary alkalinization
• Hyperkalemia
• Toxicology emergencies (e.g., salicylate toxicity)

Dosage

Children: Refer to the BNF for Children for specific dosing guidelines based on clinical condition.

Adults: Refer to the BNF for specific dosing guidelines based on clinical condition.

Mechanism of action

Bicarbonate acts as a buffering agent by neutralizing excess hydrogen ions in the blood, thus increasing blood pH. It dissociates to release bicarbonate ions, which combine with hydrogen ions to form carbonic acid, a weak acid that further dissociates into carbon dioxide and water, facilitating the removal of acid from the body via respiration and renal excretion.

Pharmacodynamics

The pharmacodynamic effects of bicarbonate are primarily related to its role in acid-base homeostasis. By increasing the bicarbonate concentration in the blood, it aids in correcting metabolic acidosis. Bicarbonate can also enhance the excretion of certain drugs and toxins from the body by altering their solubility and ionization.

Pharmacokinetics

Sodium bicarbonate is rapidly absorbed from the gastrointestinal tract following oral administration. The onset of action occurs within 30 minutes, with peak effects seen within 1 to 2 hours. It is metabolized in the body to carbon dioxide and water, with a half-life that varies based on the patient's acid-base status and renal function. The renal clearance of bicarbonate is influenced by factors such as urine pH and the presence of other electrolytes.

Contra-indications

• Metabolic alkalosis
• Hypocalcemia
• Severe respiratory disease
• Hypokalemia
• Adrenal gland disorders

Adverse effects

• Metabolic alkalosis
• Gastrointestinal discomfort
• Nausea
• Vomiting
• Flatulence
• Muscle twitching
• Tremors
• Confusion
• Irritability

Interactions

• May interact with other alkalizing agents
• May decrease the absorption of certain drugs due to increased gastric pH
• May affect the pharmacokinetics of drugs that are dependent on gastric acidity

Precautions

• Use with caution in patients with renal impairment
• Monitor serum electrolytes regularly
• Evaluate patients with a history of cardiovascular disease closely
• Use cautiously in patients on sodium-restricted diets

Pregnancy

Use only if clearly needed, as bicarbonate can alter maternal and fetal acid-base balance.

Breast-feeding

Generally considered safe, but consult healthcare provider for individual assessment.

Storage

Store in a cool, dry place, away from moisture and heat. Keep container tightly closed.

Formulations

• Sodium bicarbonate tablets
• Sodium bicarbonate powder for oral solution
• Sodium bicarbonate injection

Indications

• Acidulant in food and beverages
• Preservative in pharmaceutical formulations
• pH adjuster in various chemical preparations

Dosage

Children: Refer to product-specific guidelines for appropriate dosing based on formulation and indication.

Adults: Refer to product-specific guidelines for appropriate dosing based on formulation and indication.

Mechanism of action

Citric acid acts by chelating metal ions, which can enhance the solubility of certain compounds and improve their bioavailability. It also contributes to the acidity of the environment, which can influence enzymatic activity and metabolic pathways, particularly in the degradation of citronellol.

Pharmacodynamics

Citric acid exhibits mild pharmacological effects primarily attributed to its role in metabolic processes. It aids in the regulation of pH levels, which can impact enzymatic reactions and biochemical pathways. The acid's chelating properties may help to reduce the toxicity of certain metal ions in biological systems.

Pharmacokinetics

Citric acid is rapidly absorbed after oral administration and is metabolized in the liver. It undergoes conversion to various metabolites in the citric acid cycle, contributing to energy production. The elimination primarily occurs through urine, with minimal accumulation in the body.

Pregnancy

Citric acid is generally regarded as safe during pregnancy when used in food amounts. However, consult a healthcare provider for advice on medicinal use.

Breast-feeding

Citric acid is considered safe during breastfeeding when consumed in food amounts. For medicinal use, consult a healthcare provider.

Storage

Store in a cool, dry place away from direct sunlight.