Sodium chloride compound mixture

BackgroundSodium bicarbonate is a common household compound often promoted for unproven health benefits. However, excessive ingestion can result in severe toxicity. This report describes a case of life-threatening metabolic alkalosis and hypernatremia following self-medication and presents a systematic review of sodium bicarbonate toxicity.Case reportA previously healthy man in his 30s presented with nausea and progressive weakness after ingesting 60 g of sodium bicarbonate daily for 2 months, escalating to 480 g immediately before admission for intestinal cleansing. Laboratory evaluation demonstrated severe metabolic alkalosis (pH 7.54; HCO₃- 54.5 mmol/L), hypernatremia (serum sodium 162 mEq/L), and chloride-resistant alkalosis. Supportive therapy, including oral acetazolamide, resulted in rapid biochemical normalization and complete clinical recovery.ReviewOur systematic review of 78 cases of sodium bicarbonate toxicity identified a shift in reported indications from dyspepsia to diverse uses, including pica, drug test avoidance, and natural remedies. Clinical presentations differed by ingestion pattern: acute, massive ingestion was often complicated by gastric rupture and was associated with high mortality, whereas chronic ingestion predominantly caused severe metabolic alkalosis and electrolyte abnormalities.ConclusionExcessive sodium bicarbonate ingestion can cause life-threatening complications. Clinicians should be alert to the risks of misuse driven by widely circulating unproven health claims.

Abstract licence: CC BY-NC-ND

Sodium bicarbonate positively impacts performance, but its associated gastrointestinal symptoms (GIS) may limit use. This systematic review synthesized literature that has evaluated GIS with sodium bicarbonate supplementation. Literature searches were performed from February 2024-March 2026. Eligible studies provided ≥ 5 g of sodium bicarbonate within a 24-h period or, if a multi-day protocol, at least one day involving ≥ 5 g. Included studies had a placebo group/condition or a comparison group/condition that created a contrast related to delivery method, form, or dose. In total, 101 investigations were summarized in six categories: acute single dosing (n = 35); acute spread dosing (n = 28); chronic dosing (n = 7); acute versus chronic dosing (n = 5); delivery form (n = 18); and other (n = 8). Existing literature suggests that common acute doses (0.2-0.4 g/kg) elicit mild-to-severe GIS, which likely increase in a dose-dependent manner when sodium bicarbonate is ingested in a single dose. Strategies to reduce GIS with acute dosing include spreading intake over hours, using enteric-coated capsules/tablets, and ingesting sodium bicarbonate mini-tablets within a carbohydrate hydrogel. Direct comparisons of these strategies to reduce GIS are absent in current literature; thus, ranking their effectiveness is not possible. Multi-day dosing may lessen GIS, but symptom documentation throughout supplementation periods is poorly characterized. Notably, 26 of 101 studies failed to perform inferential statistical testing to examine condition/group differences in GIS. Making definitive recommendations about sodium bicarbonate supplementation to minimize GIS remains challenging. Major needs remain for direct comparisons between protocols purported to reduce GIS and improvements in GIS data collection, reporting, and analysis.

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Diabetic ketoacidosis (DKA) is a life-threatening metabolic complication of diabetes mellitus requiring aggressive intravenous fluid resuscitation. Although the recommended fluid has always been 0.9% normal saline (NS), its supraphysiological chloride load may induce hyperchloremic metabolic acidosis, potentially complicating DKA management. Balanced crystalloids (BCs), with electrolyte compositions more closely approximating human plasma, have emerged as potentially advantageous alternatives. This systematic review compares the clinical outcomes of NS with BCs for fluid resuscitation in patients with DKA. A comprehensive literature search was conducted in PubMed/MEDLINE, Scopus, Embase, and CENTRAL (2021-2026) following PRISMA guidelines. Studies that directly compared 0.9% NS with BCs (such as lactated Ringer's (LR) solution, Plasma-Lyte 148, Isolyte, Sterofundin, or other balanced electrolyte solutions (BES)) for DKA resuscitation were included. The outcomes of interest included time to DKA resolution, electrolyte profiles, insulin infusion duration, length of stay (LOS), acute kidney injury (AKI), and mortality. The risk of bias (ROB) was assessed using the Risk of Bias in Non-randomized Studies of Interventions (ROBINS-I) (for non-randomized studies) and RoB 2 (for randomized controlled trials (RCTs)). Nine studies, four RCTs and five non-randomized studies, comprising 1416 patients, met the inclusion criteria. BCs consistently reduced hyperchloremia and improved bicarbonate profiles compared with NS. Insulin infusion duration was significantly shorter with BCs in two studies. Length-of-stay outcomes were mixed, with some studies showing shorter hospital or ICU stays with BCs. No significant differences in AKI incidence or mortality were observed between groups. The ROB ranged from moderate to substantial, although the RCTs demonstrated a lower ROB than the retrospective cohort studies. BCs demonstrated superior electrolyte profiles and comparable safety compared with NS in DKA. However, their effect on clinically meaningful outcomes such as time to DKA resolution remains uncertain. While the biochemical advantages support consideration of BC, definitive practice recommendations await higher-certainty evidence.

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ObjectiveTo systematically synthesize evidence from RCTs that evaluate the efficacy and safety of balanced crystalloids compared with normal saline for initial fluid resuscitation of patients with DKA.MethodsThis systematic review and meta-analysis were performed considering PRISMA guidelines and was registered in PROSPERO. A comprehensive search was performed to identify RCTs comparing balanced crystalloids with normal saline in adults and children with DKA. The risk of bias was assessed by using Cochrane RoB 2 tool. A random-effects meta-analysis was performed using R software to calculate pooled Mean Differences for continuous outcomes and Odds Ratios for dichotomous outcomes with 95% Confidence Intervals.ResultsEleven RCTs were included. In the quantitative synthesis of six RCTs (n = 491) using continuous time-to-event data, balanced crystalloids were not associated with a statistically significant reduction in time to DKA resolution compared with normal saline (Mean Difference [MD] = -1.50 hours; 95% CI: -3.79 to 0.79; p=0.15), with moderate heterogeneity (I2 = 36.2%). The 95% prediction interval ranged from -5.44 to 2.44 hours. However, balanced crystalloids resulted in a significantly greater increase in serum bicarbonate at 12 hours (MD = +2.50 mmol/L; 95% CI: 1.51 to 3.48; p=0.004; I2 = 0.0%). Subgroup analyses by fluid type, DKA severity, and age group showed no significant subgroup differences.ConclusionInitial fluid resuscitation with balanced crystalloids was not associated with a shorter time to DKA resolution compared with normal saline, and they were associated with a rapid increase in serum bicarbonate levels; however, this biochemical improvement did not translate into a shorter time to DKA resolution or other clinical benefits. The choice of crystalloids for initial DKA resuscitation remains an area of clinical equipoise because of the substantial heterogeneity and methodological limitations of the available evidence, emphasizing the need for further high-quality research.

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