What should people with gout pay attention to when using sodium bicarbonate to alkalinize urine?

A friend who suffers from gout told Huazi that he had taken drugs to lower uric acid before, but was worried that long-term use would have side effects and affect liver and kidney function. So after the uric acid level dropped, he switched to taking sodium bicarbonate to alkalize the urine, hoping to lower blood uric acid by promoting uric acid excretion, but the effect was not ideal. Small stones appeared in his kidneys and gout occurred from time to time.

Huazi said that although sodium bicarbonate can alkalize urine, it is not very effective in controlling blood uric acid, and there are some things that need to be paid attention to during use.

1. Urine is not as alkaline as possible

People with elevated blood uric acid levels basically know that alkalinizing urine can promote uric acid excretion. This is because uric acid is an acidic substance and can increase its solubility in alkaline solutions. However, as the alkalinity of urine increases, the solubility of alkaline substances decreases. When the urine pH value is greater than 7, although uric acid excretion will increase, calcium salt stones are more likely to occur.

Sodium bicarbonate cannot reduce uric acid synthesis or promote uric acid excretion. Although alkalinizing urine can increase the solubility of uric acid, it cannot significantly reduce the level of uric acid in the blood. Therefore, when using sodium bicarbonate, do not take an excessive amount of medication. The normal dosage is 3 times a day, 1 to 2 tablets each time. It is recommended to prepare pH test paper to measure the pH value of urine during medication and control the pH value between 6 and 7.

Second, adverse reactions of sodium bicarbonate

Oral sodium bicarbonate cannot directly alkalinize urine. Instead, it first combines with gastric acid in the stomach. The excess is then absorbed into the blood and then enters the urine through the kidneys, thus alkalinizing urine. The production of gastric acid requires hydrogen atoms (H+) from the blood, which can also indirectly increase the alkalinity of urine.

In the process of sodium bicarbonate neutralizing gastric acid, a large amount of carbon dioxide will be produced, causing symptoms such as bloating and abdominal discomfort. For people who already have gastric ulcers, taking sodium bicarbonate may aggravate the symptoms of ulcers. If too much carbon dioxide is produced, it may even cause gastric rupture.

People with high blood pressure need to limit their sodium ion intake, and sodium bicarbonate contains sodium ions. If you take one tablet three times a day, it is equivalent to an additional intake of 0.41 grams of sodium per day, which is roughly equivalent to more than 1 gram of salt. You should pay attention to reducing the corresponding amount of salt in your diet to avoid excessive sodium ion intake, which will cause water and sodium retention, aggravate high blood pressure, and even induce heart failure.

When taking sodium bicarbonate for a long time, a large amount of gastric acid is neutralized, and the free hydrogen atoms in the blood are reduced, which will increase the hydrogen-potassium exchange mechanism of the cells. The cells release hydrogen ions into the blood, and the potassium ions outside the cells enter the cells, which reduces the potassium ion level in the blood and may cause hypokalemia.

3. Interaction with other drugs

1. Impact on absorption: Sodium bicarbonate will increase the pH value in the stomach. Some drugs that require acidic conditions for absorption will have reduced efficacy due to reduced absorption. For example, the absorption of warfarin, ranitidine, tetracycline antibiotics, iron, calcium and other drugs will be reduced. It is recommended that the time of taking sodium bicarbonate be 2 to 3 hours apart from other drugs to reduce the impact on the absorption of other drugs.

2. Affecting excretion: Sodium bicarbonate alkalinizes urine, which can increase the solubility of uric acid and increase excretion, but it will also increase the excretion of other acidic drugs. For example, the excretion of antiplatelet aspirin, phenytoin sodium and valproic acid for treating epilepsy will increase, and the efficacy will decrease.

The excretion of alkaline drugs will decrease, such as ephedrine, quinidine and other drugs, which may accumulate and increase toxicity. Drugs whose excretion is easily affected should be avoided as much as possible for combined use or dosage adjustment.

In summary, using sodium bicarbonate alone to alkalinize urine does not significantly reduce blood uric acid levels. People with gout need to use uric acid-lowering drugs such as Febuxostat and Benzbromarone at the same time to effectively control blood uric acid levels and prevent gout attacks. When using sodium bicarbonate, you should also pay attention to adverse reactions and interactions with other drugs.

Medicines need to be used under the guidance of a doctor. If you have any questions about the use of medicines, please consult a doctor or pharmacist. I am pharmacist Huazi. Welcome to follow me and share more health knowledge.