Severe metabolic alkalosis and hypernatremia induced by excessive sodium bicarbonate intake: A case report and literature review

Sodium 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. A 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. Our 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. Excessive sodium bicarbonate ingestion can cause life-threatening complications. Clinicians should be alert to the risks of misuse driven by widely circulating unproven health claims.