Table I.
List of reported cases of baking soda toxicity in adult patients.
| First author, year | Presentation | Medical history | Baking soda exposure | Laboratory values | (Refs.) |
|---|---|---|---|---|---|
| Al-Abri and Olson, 2013 | Metabolic alkalosis Ventricular tachycardia | HTN DM Zollinger-Ellison syndrome | Antacid replacement: 1 teaspoon of baking soda on an as needed basis for years | pH 7.5 HCO3 | (6) |
| 46 mmol/l | |||||
| K+ 2.0 mEq/l | |||||
| Na+ 122 mEq/l | |||||
| Cl- 59 mEq/l | |||||
| Cr 0.9 mg/dl | |||||
| Cervantes et al, 2020 | Metabolic alkalosis | CKD G3bA1 HTN AF Hyperlipidemia GERD | Topical use three times/day for tooth hygiene for the previous 6 months | pH 7.5 | (8) |
| HCO3 44 mmol/l | |||||
| K+ 3.6 mEq/l | |||||
| Na+ 146 mEq/l | |||||
| Cl- 95 mEq/l | |||||
| Cr 1.37 mg/dl | |||||
| Solak et al, 2009 | Metabolic alkalosis Sleep apnea Volume overload Uncontrolled HTN | ESRD CHF DM type 2 Hypothyroidism Chronic gastritis | Antacid abuse: 4-5 packs of baking soda a day over the last month Cl- 83 mEq/l | pH 7 637 | (9) |
| HCO3 45 mmol/l | |||||
| K+ 3.3 mEq/l | |||||
| Na+ 141 mEq/l | |||||
| Sahani et al, 2001 | Metabolic alkalosis | ESRD | Hiccup relief: Consumption of ¾ bottle of Bromo-Seltzer (containing 89 g sodium bicarbonate) | pH 7.53 HCO3 | (10) |
| 40 mmol/l K+ | |||||
| 3.5 mEq/l | |||||
| Na+ 143 mEq/l | |||||
| Cl- 89 mEq/l | |||||
| Cr 1.0 mg/dl | |||||
| Galinko et al, 2017 | Metabolic alkalosis Acute kidney injury Acute hypoxic respiratory failure Lactic acidosis Altered mental state Ventricular tachycardia | HTN Meningioma (surgical resection, ventriculoperitoneal shunt and radiation therapy) Breast cancer | Alternative topical treatment for breast cancer -113 g of baking soda applied topically every 4 days for several weeks | pH 7.66 | (11) |
| HCO3 >45 mmol/l | |||||
| K+ 2.6 mEq/l | |||||
| Na+ 158 mEq/l | |||||
| Cl- 92 mEq/l | |||||
| Cr 1.9 mg/dl | |||||
| Soliz et al, 2014 | Metabolic alkalosis | Colon cancer Sinonasal melanoma | Alternative treatment for colon cancer: 1 liter of pH 7.8-8 water obtained from bottled water, key lime juice a quarter of tablespoon baking soda | pH 7.65 | (12) |
| HCO3 39 mmol/l | |||||
| K+ 2.6 mEq/l | |||||
| Na+ 123 mEq/l | |||||
| Okada et al, 1996 | Metabolic alkalosis and myoclonus | HTN Cerebral infarction Gastrectomy (gastric ulcer) | Antacid (625 mg sodium bicarbonate) for a 6-month period | pH 7.481 | (13) |
| HCO3 33.9 mmol/l | |||||
| K+ 2.7 mEq/l | |||||
| John et al, 2012 | Metabolic alkalosis Respiratory alkalosis High-anion gap metabolic acidosis | Foot ulcers for 2 years | Ingestion and application of baking soda to leg ulcers for 1.5 years | pH 7.69 | (14) |
| HCO3 54 mmol/l | |||||
| K+ 1.8 mEq/l | |||||
| Na+ 148 mEq/l | |||||
| Cl- 73 mEq/l | |||||
| Cr 3.4 mg/dl | |||||
| Hughes et al, 2016 | Metabolic alkalosis Hypernatremia Hemorrhagic encephalopathy Altered mental state | Schizophrenia Polysubstance abuse | Patient was unable to explain cause of ingestion- 1 box of baking soda (454 g) | pH 7.53 | (15) |
| HCO3 50 mEq/l | |||||
| K+ 2.5 mEq/l | |||||
| Na+ 172 mEq/l | |||||
| Cl- 98 mEq/l | |||||
| Glucose | |||||
| 433 mg/dl Cr | |||||
| 1.85 mg/dl | |||||
| Ajbani et al, 2011 | Metabolic alkalosis | HTN COPD | Antacid replacement: Unknown quantity of baking soda over several weeks | pH 7.59 | (16) |
| HCO3 56 mmol/l | |||||
| K+ 1.7 mEq/l | |||||
| Na+ 121 mEq/l | |||||
| Cl- 53 mEq/l | |||||
| Cr 3.3 mg/dl | |||||
| Fitzgibbons and Snoey, 1999 (Case 1) | Metabolic alkalosis Ventricular tachydysrhythmia | Peptic ulcer disease with perforation | Antacid replacement: Several tablespoons of baking soda | pH 7.56 | (17) |
| HCO3 58 mmol/l | |||||
| K+ 1.8 mEq/l | |||||
| Na+ 129 mEq/l | |||||
| Cl- 55 mEq/l | |||||
| Cr 2.8 mg/dl | |||||
| Fitzgibbons and Snoey, 1999 (Case 2) | Metabolic alkalosis Altered mental state | HTN Herpes zoster infection Hepatitis | Antacid replacement: One box of baking soda | pH 7.49 | (17) |
| HCO3 41 mmol/l | |||||
| K+ 2.8 mEq/l | |||||
| Na+ 146 mEq/l | |||||
| Cl- 90 mEq/l | |||||
| Cr 0.9 mg/dl | |||||
| Thomas and Stone, 1994 | Metabolic alkalosis | Alcoholic esophagitis and gastritis | Antacid misuse: 10-12 oz of baking soda | pH 7.55 | (18) |
| HCO3 44.5 mmol/l | |||||
| Na+ 136 mEq/l | |||||
| K+ 2.5 mEq/l | |||||
| Cl- 77 mEq/l | |||||
| Cr 2.4 mg/dl | |||||
| Gawarammana et al, 2007 | Metabolic alkalosis Coma (GCS 3/15) | N/A | Antacid: 2 liters of Gaviscon in the prior 48 h | pH 7.54 | (19) |
| HCO3 50.6 mmol/l | |||||
| K+ 1.6 mEq/l | |||||
| Na+ 127 mEq/l | |||||
| Cl- 66 mEq/l | |||||
| Mennen and Slovis, 1988 | Metabolic alkalosis Cardiopulmonary arrest Death | HTN Peptic ulcer disease Alcohol abuse Seizure disorder | Antacid misuse: Amount unknown | pH 7.73 | (20) |
| HCO3 >40 mmol/l | |||||
| Na+ 154 mEq/l | |||||
| K+ 3.2 mEq/l | |||||
| Cl- 53 mEq/l | |||||
| Cr 1.4 mg/dl | |||||
| Forslund et al, 2008 | Metabolic alkalosis Epileptiformic convulsions Subdural hemorrhage Rhabdomyolysis | Alcohol abuse | Antacid abuse: 40 years history of baking soda abuse; 10-15 g daily initially, slowly increasing up to 50 g daily during last year | pH 7.57 | (21) |
| HCO3 85 mmol/l | |||||
| K+ 2.3 mEq/l | |||||
| Na+ 147 mEq/l | |||||
| Cl- 46 mEq/l | |||||
| Yi et al, 2012 | Metabolic alkalosis | Alcohol abuse | Antacid replacement: 3-5 tablespoons daily | pH 7.6 | (22) |
| HCO3 53 mmol/l | |||||
| K+ 1.6 mEq/l | |||||
| Na+ 131 mEq/l | |||||
| Cl- 65 mEq/l | |||||
| Cr 3.8 mg/dl | |||||
| Scolari Childress and Myles, 2013 | Rhabdomyolysis Peripartum cardiomyopathy | Pregnant, at 37 weeks of gestation with history of hyperemesis and iron-deficiency anemia | Hiccup remedy: A box of baking soda (454 g) every day for several years | Hb 8.2 g/dl Ht 26.3% | (23) |
| K+ 2.1 mmol/l | |||||
| AST 134 U/l | |||||
| ALT 60 U/l | |||||
| Lazebnik et al, 1986 | Stomach rupture | N/A | Antacid misuse: One tablespoon of sodium bicarbonate | N/A | (24) |
| Linford and James, 1986 | Metabolic alkalosis | N/A | Bicarbonate abuse: 50-150 g daily | HCO3 >40 mmol/l K+ 1.8 mEq/l | (25) |
| Okada et al, 1999 | Metabolic alkalosis Sleep apnea Hypertension | ESRD | Antacid replacement: | pH 7.47 HCO3 | (26) |
| 40.1 mmol/l |
Normal ranges: Cr, 0.6-1.2 mg/dl; HCO3- in blood plasma, 22-29 mmol/l; pH in blood plasma, 7.31-7.41; serum K+, 3.5-5.1 mEq/l; serum Na+, 135-145 mEq/l; serum Cl-, 94-110 mEq/l; ALT, 4-33 U/L; AST, 8-35 U/l; Hb, 13-16 g/dl; Ht, 40-50%. AF, atrial fibrillation; CHF, congestive heart failure; CKD, chronic kidney disease; COPD, chronic obstructive pulmonary disease; DM, diabetes mellitus; GCS, Glasgow Coma Scale; GERD, gastroesophageal reflux disease; HTN, hypertension; ESRD, end-stage renal disease; AST, aspartate transaminase; ALT, alanine transaminase; N/A, not applicable; Cr, serum creatinine; ALT, alanine transaminase; AST, aspartate transaminase; Hb, hemoglobin; Ht, hematocrit.