Description

The combination of Sodium Bicarbonate, Sodium Citrate, Citric Acid, and Tartaric Acid is a multi-component, effervescent granular powder. This formulation is designed to be dissolved in water before consumption, creating a bubbly solution. The core components work together as a systemic alkalinizing agent and a topical antacid. Sodium Bicarbonate is an alkaline salt, while Citric and Tartaric Acids provide the acidic component for the effervescence. Sodium Citrate serves as a buffer and the primary agent for systemic alkalinization.

Indication

This combination is indicated for two primary therapeutic purposes:

1. Antacid and Symptomatic Relief: It is used for the symptomatic relief of conditions related to excess stomach acidity, such as:
   • Dyspepsia (indigestion)
   • Heartburn
   • Gastric discomfort
2. Urinary and Systemic Alkalinizer: This is its more significant and frequent use. It is indicated for:
   • Urinary Alkalinization: To increase the pH of the urine to prevent the formation of and aid in the dissolution of certain types of kidney stones, specifically uric acid and cystine stones.
   • Gout: To help prevent the crystallization of uric acid in the kidneys and joints.
   • Supportive Therapy: As an adjunct therapy in the treatment of certain drug overdoses (e.g., salicylates, phenobarbital) to enhance their renal excretion by making the urine more alkaline.

Mechanism of Action

The therapeutic effects of this combination are based on two distinct mechanisms:

1. Antacid Mechanism:
   • When the powder is dissolved in water, the sodium bicarbonate reacts with the citric acid and tartaric acid, releasing carbon dioxide gas, which creates the effervescence.
   • When ingested, the remaining sodium bicarbonate directly neutralizes the hydrochloric acid (HCl) in the stomach.
   • The chemical reaction is: NaHCO3​+HCl→NaCl+H2​O+CO2​.
   • This direct neutralization rapidly reduces stomach acidity, providing immediate relief from heartburn and indigestion.
2. Urinary Alkalinizing Mechanism:
   • This is the more systemic effect, primarily driven by the citrate component (from both Sodium Citrate and the metabolism of Citric Acid).
   • When absorbed from the gastrointestinal tract, citrate ions are metabolized by the liver into bicarbonate (HCO3−​).
   • The liver’s metabolic process consumes a proton (H+) for every molecule of citrate metabolized, resulting in a net gain of bicarbonate in the bloodstream.
   • The kidneys then excrete this newly generated bicarbonate.
   • The presence of bicarbonate in the urine increases the urine’s pH (makes it more alkaline).
   • This alkalinization is crucial for:
     • Kidney Stone Prevention: Uric acid and cystine are less soluble in acidic urine and tend to crystallize. By increasing the urinary pH, their solubility is increased, preventing the formation of new stones and helping to dissolve existing ones.
     • Enhanced Drug Excretion: The excretion of certain acidic drugs (e.g., salicylates) is increased in alkaline urine, a principle known as “ion trapping.”