탄산수소나트륨
Sodium Bicarbonate
Sodium hydrogen carbonate
다른 이름: Baking soda · Neut · Zegerid · E500 · monosodium carbonate · natrii bicarbonas · natrii hydrogenocarbonas · sal de vichy · sodium acid carbonate · NaHCO3 · sodium hydrogen carbonate
VetSheet 수의사 팀 검수업데이트 2026년 4월 5일근거 기반 수의학 참고자료
용량은 수의사 전문가를 위한 임상 참고자료입니다. 반드시 최신 약물 정보 및 개별 환자에 따라 확인하시기 바랍니다.
동물 종별 용량
🌎 NA — North America🌍 EU — Europe
개
| 적응증 | 용량 | 경로 | 빈도 | 기간 | 지역 |
|---|---|---|---|---|---|
| Severe metabolic acidosis | mEq of bicarbonate required = 0.5 x body weight in kg x (desired total CO2 mEq/L minus measured total CO2 mEq/L). Give 1/2 of the calculated dose slowly over 3-4 hours IV. | IV | Once | Over 3-4 hours | 🌎 NA |
| Metabolic acidosis secondary to uremia | 0.3 x body weight (kilograms) x the base deficit. Administration of one third of this dose slowly IV and the rest placed in the intravenous fluids. OR 1-2 mEq/kg of bicarbonate can be given as a slow IV bolus if blood gas is not possible. | IV | Once | Over several hours | 🌎 NA |
| Adjunctive therapy of diabetic ketoacidosis | Dose (in mEq) = body weight in kgs. x 0.4 x (12 - patient's bicarbonate) x 0.5. Give above dose over 6 hours in IV fluids. | IV | Once | Over 6 hours | 🌎 NA |
| Adjunctive treatment of hypercalcemic crisis | mEq of bicarbonate required = 0.3 x body weight in kg x (desired plasma bicarbonate mEq/L - measured plasma bicarbonate mEq/L); or 1 mEq/kg IV every 10-15 minutes; maximum total dose: 4 mEq/L | IV | q10-15m | Until effect or max dose | 🌎 NA |
| Adjunctive therapy for hyperkalemic crises | 2-3 mEq/kg IV over 30 minutes (if decreased tissue perfusion/renal failure and no DKA) OR 1-2 mEq/kg IV slowly | IV | Once | Over 30 minutes or slowly | 🌎 NA |
| To alkalinize the urine | 10-90 grains (650 mg-5.85 grams) PO per day | PO | Daily | Ongoing | 🌎 NA |
| Dissolution and/or prevention of urate urolithiasis | 0.5-1 gram (1/8-1/4 tsp.) per 5 kg of body weight three times daily PO | PO | q8h | Ongoing | 🌎 NA |
- Severe metabolic acidosis: Recheck blood gases and assess clinical status. Avoid over-alkalinization.
- Metabolic acidosis secondary to uremia: Avoid rapid IV boluses. Recheck blood gas after 2-4 hours.
- Adjunctive therapy of diabetic ketoacidosis: Only if plasma bicarbonate is <=11 mEq/L. Recheck and repeat if still <=11 mEq/L. Use is controversial.
- Adjunctive therapy for hyperkalemic crises: Must be used judiciously.
- To alkalinize the urine: Goal is urine pH of about 7; avoid pH >7.5.
- Dissolution and/or prevention of urate urolithiasis: Goal is urine pH of 7-7.5.
고양이
| 적응증 | 용량 | 경로 | 빈도 | 기간 | 지역 |
|---|---|---|---|---|---|
| Severe metabolic acidosis | mEq of bicarbonate required = 0.5 x body weight in kg x (desired total CO2 mEq/L minus measured total CO2 mEq/L). Give 1/2 of the calculated dose slowly over 3-4 hours IV. | IV | Once | Over 3-4 hours | 🌎 NA |
| Metabolic acidosis secondary to uremia | 0.3 x body weight (kilograms) x the base deficit. Administration of one third of this dose slowly IV and the rest placed in the intravenous fluids. OR 1-2 mEq/kg of bicarbonate can be given as a slow IV bolus if blood gas is not possible. | IV | Once | Over several hours | 🌎 NA |
| Adjunctive therapy of diabetic ketoacidosis | Dose (in mEq) = body weight in kgs. x 0.4 x (12 - patient's bicarbonate) x 0.5. Give above dose over 6 hours in IV fluids. | IV | Once | Over 6 hours | 🌎 NA |
| Adjunctive treatment of hypercalcemic crisis | mEq of bicarbonate required = 0.3 x body weight in kg x (desired plasma bicarbonate mEq/L - measured plasma bicarbonate mEq/L); or 1 mEq/kg IV every 10-15 minutes; maximum total dose: 4 mEq/L | IV | q10-15m | Until effect or max dose | 🌎 NA |
| Adjunctive therapy for hyperkalemic crises | 2-3 mEq/kg IV over 30 minutes (if decreased tissue perfusion/renal failure and no DKA) OR 1-2 mEq/kg IV slowly | IV | Once | Over 30 minutes or slowly | 🌎 NA |
| To alkalinize the urine | 10-90 grains (650 mg-5.85 grams) PO per day | PO | Daily | Ongoing | 🌎 NA |
- Severe metabolic acidosis: Recheck blood gases and assess clinical status. Avoid over-alkalinization.
- Metabolic acidosis secondary to uremia: Avoid rapid IV boluses. Recheck blood gas after 2-4 hours.
- Adjunctive therapy of diabetic ketoacidosis: Only if plasma bicarbonate is <=11 mEq/L. Recheck and repeat if still <=11 mEq/L. Use is controversial.
- Adjunctive therapy for hyperkalemic crises: Must be used judiciously.
- To alkalinize the urine: Goal is urine pH of about 7; avoid pH >7.5.
새
| 적응증 | 용량 | 경로 | 빈도 | 기간 | 지역 |
|---|---|---|---|---|---|
| Metabolic acidosis | 1 mEq/kg initially IV (then SC) for 15-30 minutes to a maximum of 4 mEq/kg | IV/SC | Once | 15-30 minutes | 🌎 NA |
말
| 적응증 | 용량 | 경로 | 빈도 | 기간 | 지역 |
|---|---|---|---|---|---|
| Metabolic acidosis (associated with colic) | bicarbonate deficit (HCO3 mEq) = base deficit (mEq/L) x 0.4 x body weight (kg). May administer as a 5% sodium bicarbonate solution. Should not be administered any faster than 1-2 L/hr. | IV | Once | Continuous infusion | 🌎 NA |
- Metabolic acidosis (associated with colic): If pH is <7.3 and base deficit is >10 mEq/L. May be preferable to give as isotonic sodium bicarbonate (150 mEq/L) if dehydrated.
소
| 적응증 | 용량 | 경로 | 빈도 | 기간 | 지역 |
|---|---|---|---|---|---|
| Acidosis | 2-5 mEq/kg IV for a 4-8 hour period | IV | Once | Over 4-8 hours | 🌎 NA |
| Severely dehydrated acidotic calves | Isotonic sodium bicarbonate (156 mEq/L). Most calves require about 2 liters of this solution given over 1-2 hours, then change to isotonic saline and sodium bicarbonate or a balanced electrolyte solution. | IV | Once | Over 1-2 hours | 🌎 NA |
- Severely dehydrated acidotic calves: Isotonic solution: 13 grams of sodium bicarbonate in 1 L of sterile water.
양
| 적응증 | 용량 | 경로 | 빈도 | 기간 | 지역 |
|---|---|---|---|---|---|
| Acidosis (Ruminants) | 2-5 mEq/kg IV for a 4-8 hour period | IV | Once | Over 4-8 hours | 🌎 NA |
염소
| 적응증 | 용량 | 경로 | 빈도 | 기간 | 지역 |
|---|---|---|---|---|---|
| Acidosis (Ruminants) | 2-5 mEq/kg IV for a 4-8 hour period | IV | Once | Over 4-8 hours | 🌎 NA |
용량은 수의사 전문가를 위한 임상 참고자료입니다. 반드시 최신 약물 정보 및 개별 환자에 따라 확인하시기 바랍니다.
개요
탄산수소나트륨은 수의 응급 및 중환자 치료뿐만 아니라 특정 질환의 만성 관리에 널리 사용되는 전신 및 요 알칼리화제입니다.
- 응급 산-염기 관리: 주로 근본 원인을 신속하게 되돌릴 수 없고 혈액 pH가 위험한 수준으로 떨어졌을 때 심각한 대사성 산증을 교정하는 데 사용됩니다.
- 전해질 위기: 생명을 위협하는 고칼륨혈증(칼륨을 세포 내로 이동시킴) 및 고칼슘혈증의 보조 치료제로 사용됩니다.
- 요 알칼리화: 소변 pH를 높여 특정 요석(예: 요산염, 시스틴)을 관리하거나 예방하기 위해 경구 투여합니다.
임상 팁: 심폐소생술(CPR) 및 당뇨병성 케톤산증(DKA)에서 탄산수소나트륨의 일상적인 사용은 더 이상 권장되지 않습니다. DKA에서는 세포 내 저칼륨혈증을 악화시키고 역설적 중추신경계 산증을 유발할 수 있습니다. CPR 중에는 환자의 환기가 충분하지 않으면 고탄산혈증을 유발할 수 있습니다.
작용 기전
Sodium bicarbonate acts as an exogenous source of bicarbonate anion ($HCO_3^-$), which is the primary extracellular buffer in the body.
- Buffering Acidosis: $HCO_3^-$ combines with free hydrogen ions ($H^+$) to form carbonic acid ($H_2CO_3$), which then dissociates into water ($H_2O$) and carbon dioxide ($CO_2$).
- Pathway: $HCO_3^-$ + $H^+$ → $H_2CO_3$ → $H_2O$ + $CO_2$ (The $CO_2$ must be exhaled via the lungs, highlighting the need for adequate ventilation).
- Hyperkalemia Management: By increasing blood pH, it stimulates the $Na^+/H^+$ exchanger and subsequently the $Na^+/K^+$-ATPase pump, driving potassium into cells and rapidly lowering serum potassium levels.
- Urinary Alkalinization: Bicarbonate is excreted in the urine, raising the pH. This increases the solubility of weak acids (like uric acid and cystine) and decreases the solubility of weak bases.
안전성·주의사항
금기사항
- Metabolic or respiratory alkalosis
- Excessive chloride loss secondary to vomiting or GI suction
- Patients at risk for development of diuretic-induced hypochloremic alkalosis
- Hypocalcemia (alkalosis may induce tetany)
- Hypoventilating patients
- Hypercapnoeic patients
- Animals unable to effectively expel carbon dioxide
부작용
- Metabolic alkalosis
- Hypokalemia
- Hypocalcemia
- 'Overshoot' alkalosis
- Hypernatremia
- Volume overload
- Shifts in the oxygen dissociation curve (decreased tissue oxygenation)
- Paradoxical CNS acidosis leading to respiratory arrest
- Hypercapnia (if not well ventilated during CPR)
- Predisposition to ventricular fibrillation
- Hypernatraemia
- Congestive heart failure (due to sodium load)
- Decreased tissue oxygenation (shift in oxygen dissociation curve)
주의
Extreme Caution: Use with extreme caution and give very slowly in patients with hypocalcemia to avoid inducing tetany. Caution: Because of the potential sodium load, use with caution in patients with congestive heart failure (CHF), nephrotic syndrome, hypertension, oliguria, acute renal failure, or volume overload. Ventilation: When used during CPR, ensure the patient is well ventilated to prevent hypercapnia and paradoxical CNS acidosis.
약물 상호작용
Concomitant oral sodium bicarbonate may reduce absorption; administer separately
Concomitant oral sodium bicarbonate may reduce absorption; administer separately
Solubility is decreased in an alkaline environment; monitor for signs of crystalluria
Patients receiving high dosages of sodium bicarbonate and ACTH or glucocorticoids may develop hypernatremia
Concurrent use in patients receiving potassium-wasting diuretics may cause hypochloremic alkalosis
When urine is alkalinized, excretion may be decreased
Concomitant oral sodium bicarbonate may reduce absorption; administer separately
Concomitant oral sodium bicarbonate may reduce absorption; administer separately
Can increase or reduce absorption rate/extent; avoid giving other drugs within 12 hours of oral sodium bicarbonate
When urine is alkalinized, excretion may be decreased
When urine is alkalinized, excretion of weakly acidic drugs may be increased
Oral sodium bicarbonate may reduce efficacy if administered concurrently
Concomitant oral sodium bicarbonate may reduce absorption; administer separately
Incompatible in solution; do not mix unless checked beforehand (risk of precipitation)
Decreased excretion due to alkalinization of the urine
Increased excretion due to alkalinization of the urine
Increased excretion due to alkalinization of the urine
Increased excretion due to alkalinization of the urine
모니터링
- Acid/base status (venous or arterial blood gases)
- Serum electrolytes (especially potassium, calcium, and sodium)
- Urine pH (if being used to alkalinize urine)
- Blood gas analysis (pH, pCO2, HCO3-)
- Serum electrolytes (Na+, K+, Ca2+)
- Respiratory rate and effort
- Clinical signs of fluid overload or congestive heart failure
약동학
흡수
Well absorbed orally.
분포
Bicarbonate increases initially in the intravascular space, but is then buffered by intracellular buffers. Diffusion and buffering by intracellular buffers takes approximately 2-4 hours.
대사
Combines with hydrogen ions to form carbonic acid, which dissociates into water and carbon dioxide (exhaled by the lungs).
배설
Filtered and reabsorbed by the kidneys; excess is excreted in the urine, resulting in urinary alkalinization.
과다투여
Overdose or overly rapid administration can cause severe alkalosis, leading to irritability, muscle twitching, or tetany (due to a sudden drop in ionized calcium).
- Mild Overdose: May only require discontinuing the bicarbonate therapy or using a rebreathing mask.
- Severe Alkalosis: May require intravenous calcium therapy to treat tetany.
- Electrolyte Correction: Sodium chloride or potassium chloride may be necessary if hypokalemia or hypochloremia is present.
Always thoroughly check dosages and frequently monitor electrolyte and acid/base status during administration.
제품
제형
- Injection: 4%, 4.2%, 5%, 7.5%, 8.4%
- Oral tablets: 325 mg, 650 mg
- Oral powder
- Oral suspension/capsules (combination with omeprazole)
- 1.26% solution for IV infusion
- 4.2% solution for IV infusion
- 8.4% solution for IV infusion (1 mmol/ml)
- 300 mg oral tablet
- 500 mg oral tablet
- 600 mg oral tablet
동물용의약품
- Sodium Bicarbonate Injection: 8.4% (1 mEq/mL) in 50 mL, 100 mL, and 500 mL vials
인용의약품
- Sodium Bicarbonate Neutralizing Additive Solution: 4% (0.48 mEq/mL), 4.2% (0.5 mEq/mL)
- Sodium Bicarbonate Injection: 4.2%, 5%, 7.5%, 8.4%
- Sodium Bicarbonate Tablets: 325 mg & 650 mg (OTC)
- Sodium Bicarbonate Powder: 120 grams, 300 grams & 1 lb (OTC)
- Omeprazole/Sodium Bicarbonate Capsules (Zegerid): 20 mg/1,100 mg & 40 mg/1,100 mg
- Omeprazole/Sodium Bicarbonate Powder for Oral Suspension (Zegerid): 20 mg/1,680 mg & 40 mg/1,680 mg
- 1.26% IV infusion
- 4.2% IV infusion
- 8.4% IV infusion
- 300 mg tablets
- 500 mg tablets
- 600 mg tablets
규제 현황
POM (Prescription Only Medicine)
POM-V
규제 데이터 없음: 🇺🇸 US · 🇭🇰 HK · 🇹🇼 TW · 🇯🇵 JP · 🇰🇷 KR · 🇦🇺 AU
보관·안정성
Tablets should be stored in tight containers at room temperature (15-30°C). Injection should be stored at temperatures less than 40°C (preferably room temperature); avoid freezing. Powder is stable in dry air but will slowly decompose upon exposure to moist air.
보호자 정보
탄산수소나트륨(일반적으로 베이킹 소다로 알려짐)은 반려동물의 혈액이나 소변의 산성도를 낮추기 위해 의학적으로 사용됩니다.
- 투여 방법: 경구용 알약이나 가루를 투여할 경우 수의사의 정확한 복용량 지시를 따르십시오. 수의사가 특별히 지시하지 않는 한 가정용 베이킹 소다로 대체하지 마십시오. 복용량이 부정확해져 위험할 수 있습니다.
- 다른 약물과의 투여 간격: 위산 수치를 변화시켜 다른 약물의 흡수에 심각한 영향을 미칠 수 있으므로, 가능한 한 다른 경구용 약물과 12시간 간격을 두고 투여하십시오.
- 모니터링: 수의사는 복용량이 정확하고 안전한지 확인하기 위해 반려동물의 혈액 검사나 소변 pH를 정기적으로 확인해야 할 수 있습니다.
- 주의해야 할 부작용: 체액 저류의 징후(빠른 호흡, 기침 또는 부종), 근육 경련 또는 쇠약 증상이 있는지 관찰하십시오. 평소와 다른 행동이나 증상을 발견하면 즉시 수의사에게 연락하십시오.
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