Baking soda misuse as a home remedy: case experience of the California Poison Control System

Abstract

Summary What is known and objective Baking soda is a common household product promoted by the manufacturer as an antacid. It contains sodium bicarbonate and has the potential for significant toxicity when ingested in excessive amounts. Characterizing the patterns and outcomes from the misuse of baking soda as a home remedy can guide the clinical assessment and preventative counselling of patients at risk for use of this product. Methods We conducted a retrospective review of all symptomatic cases involving ingestion and misuse of a baking soda powder product that were reported to the California Poison Control System between the years 2000 and 2012. Results and discussion Of the 192 cases we identified, 55·8% were female, ages ranged 2 months to 79 years, and the most common reasons for misuse included antacid (60·4%), ‘beat a urine drug test’ (11·5%) and treat a UTI (4·7%). Most cases (55·2%) had significant symptoms warranting a medical evaluation, whereas 12 patients required hospital admission developed either electrolyte imbalances, metabolic alkalosis or respiratory depression. What is new and conclusion Misuse of baking soda can result in serious electrolyte and acid/base imbalances. Patients at highest risk of toxicity may include those who chronically use an antacid, those who use the method to ‘beat’ urine drug screens, pregnant women and young children. Self‐treatment with baking soda as a home remedy may also mask or delay medical care thereby complicating or exacerbating an existing medical problem. We suggest that healthcare providers counsel high‐risk patients about the potential complications of misuse of baking soda as a home remedy.

Severe Metabolic Alkalosis from Acute Baking Soda Ingestion Presenting with Acute Respiratory Failure and Ischemic Stroke

“…Baking soda products contain 59 mEq sodium and bicarbonate per teaspoonful [4]. The short-term administration of large amounts of sodium bicarbonate to normal individuals usually results in very rapid renal excretion of the entire alkali load with minimal increase in the bicarbonate concentration [10,11].…”

“…Reduced cerebral blood flow, cerebral vasoconstriction and CSF alkalosis has also been observed [8,13,14]. Myocardial irritability can lead to supraventricular and ventricular arrhythmias [4,9,15]. Respiratory failure is caused by compensatory hypoventilation, decreased tissue oxygen delivery from a left shift of oxygen dissociation curve (Bohr effect), and decreased sensitivity of peripheral chemoreceptors to hypoxia [16][17][18].…”

“…Patients with baking soda overdose can present with mild to severe symptoms depending on the amount and duration of ingestion [1,4,6,9,19]. Patients commonly present with abdominal symptoms like nausea and vomiting and in few severe cases can present with neurological symptoms like change in mental status, seizures, coma and even cardiopulmonary arrest [4,6,9]. Abdominal distention and possible damage or rupture of the stomach can also occur from carbon dioxide release when large amount of baking soda is ingested [23].…”

“…It is a widely available household product used for cooking, baking, personal care and cleaning purposes [3]. It has long been used also as a home remedy for heartburn and indigestion, and also misused as an agent to "beat a urine drug test" and to treat urinary infections [4]. In clinical medicine it's used to treat severe metabolic acidosis, hyperkalemia, dysrhythmias, tricyclics and diphenhydramine overdose [1,5].…”

Sodium Bicarbonate Therapy in Patients with Metabolic Acidosis

“…A recent retrospective review of symptomatic cases involving ingestion of baking soda powder (household sodium bicarbonate) reports that 192 cases were notified to the California Poison Control System between the years 2000 and 2012 and concludes that misuse of baking soda may result in severe acid-base and electrolyte alterations or respiratory depression, particularly in children, pregnant women, alcoholics, and patients on diuretics and when baking soda is used regularly as an antacid or to alter urine drugs screen tests [93]. Therapy with sodium bicarbonate may be associated with some side effects, such as hypokalemia, ionized hypocalcemia, hypercapnia, hemodynamic instability, particularly during hemodialysis sessions, prolongation of the QTc interval, a rise in the urinary excretion of sodium, and the potential to deteriorate vascular calcifications on chronic administration (Table 4).…”