QUICK FACTS
- Sodium bicarbonate has been touted as a home-remedy detox to pass a drug test.
- A quick internet search of “baking soda to pass drug test” yields >1 million search results.
- Sodium bicarbonate plus gastric acid releases carbon dioxide.
- Doses suggested on the internet for detox are not safe.
Sodium bicarbonate has long been touted among alternative remedy aficionados as an effective agent for general cleansing and detoxification of the body, skin and hair. This reputation propelled it into another customer base for home-remedy detox – the drug user facing a urine drug screen. Internet suggestions for sodium bicarbonate dose to beat a drug test range from 1 teaspoonful to as much as 3 to 5 tablespoonsful taken in water, followed by a gallon of water 1-3 hours before the test. Although the internet sources warn of diarrhea as an adverse effect, none seem to warn about anything more serious. We report a case of baking soda ingestion prior to an occupational drug screen that resulted in gastric perforation.
Case Report
An adult male presented to the ED with severe abdominal pain and vomiting. He gave a history of ingesting five tablespoons of baking soda earlier that day to clear his system of marijuana for a drug test at work. Initial electrolytes were unremarkable; notably serum sodium was 137 mEq/L. Abdominal CT revealed free air and he was taken directly to surgery. He aspirated during intubation. Perforation of the stomach was found during laparotomy, as well as peritonitis. 2.5 liters of black enteric contents were suctioned from the peritoneal cavity and the stomach was repaired. Piperacillin/tazobactam, famotidine, and hydrocortisone sodium succinate were started. On day 2, he was afebrile, hypotensive (BP 104/59, HR 128) and over breathing the ventilator. Lab results included serum Na 147, Cl 113, and K 5.3 mEq/L; and Mg 1.6 and Ca 6.9 mg/dL. The hospital course was complicated with sepsis and ARDS. By day 19, the patient was alert, ventilator independent and breathing through his tracheostomy.
Case Discussion
Gastric rupture is a rarely reported consequence of oral sodium bicarbonate. It occurs after pressurized accumulation of excessive volumes of carbon dioxide released by reaction with hydrochloric acid in a stomach already distended with food, liquid, and swallowed air. An in vitro model that simulated the stomach environment previously characterized the variables that contribute to the rapidity and quantity of CO2 gas release. These include the acidity, fluid/solid volume, and air volume of the stomach, any external release through eructation, and the weight and dilution-volume of sodium bicarbonate taken. For this patient, most of these variables are unknown except that 5 tablespoonsful of sodium bicarbonate, roughly 70 grams, is clearly an excessive dose.
Conclusion
Gastric rupture following baking soda ingestion has only been rarely reported in the literature. Although recommended dosing for indigestion on the package is almost certainly safe, the doses suggested in the wild environment of the internet are not. Because of the consumer interest in holistic-health, general detox cleansing, and drug test manipulation, poison centers should be alert to the life-threatening complication of gastric perforation.
Unusual toxicology cases, such as this baking soda exposure, can be challenging to manage. Our advice to you is to call the Missouri Poison Center. Our specially trained nurses, pharmacists and medical toxicologist can provide you with the most up-to-date treatment advice on baking soda exposures.
