What are the documented health risks of ingesting sodium bicarbonate regularly or in large doses?

1. The core metabolic danger: metabolic alkalosis and its downstream effects

Excess bicarbonate raises blood pH and serum bicarbonate, producing metabolic alkalosis that can depress respiration, shift electrolytes, and provoke confusion, muscle twitching, tetany, and seizures; blood gas and electrolyte abnormalities are repeatedly reported in case studies of baking‑soda toxicity ^{[1] [3] [4]}.

2. Sodium load and fluid shifts: hypernatremia, hypertension, and volume problems

High oral doses deliver a substantial sodium load that can cause hypernatremia and hyperosmolarity, worsen or precipitate hypertension, and lead either to intravascular volume depletion via bicarbonate diuresis or volume expansion with suppressed renin/aldosterone in different clinical settings ^{[1] [6] [2]}.

3. Electrolyte depletion: hypokalemia and hypochloremia with cardiac risk

Bicarbonate‑induced diuresis and urinary alkalinization promote loss of chloride and potassium, producing hypokalemia and hypochloremia that have been linked to arrhythmias—including supraventricular dysrhythmias and prolonged QT—reported in multiple clinical reviews ^{[2] [4] [3]}.

4. Gastrointestinal and mechanical hazards: gas, pressure, and rupture

The rapid chemical reaction of sodium bicarbonate with stomach acid generates carbon dioxide gas; case reports describe severe gastric distention and even spontaneous gastric rupture after excessive ingestion, particularly following large meals or alcohol binging ^{[7] [6] [8]}.

5. Neurological, muscular, and renal consequences: encephalopathy, rhabdomyolysis, AKI

Acute severe ingestions have produced altered mental status and hemorrhagic encephalopathy, and case series link toxicity to rhabdomyolysis, acute kidney injury, and in some reports liver injury—mechanisms include extreme electrolyte shifts, impaired renal bicarbonate excretion, and altered drug clearance ^{[3] [5] [9]}.

6. Drug interactions and vulnerable populations

Sodium bicarbonate changes urine and systemic pH and can alter the absorption and elimination of other drugs—raising pseudoephedrine levels, accelerating aspirin breakdown, and decreasing renal clearance of some anti‑inflammatories—so concurrent medication use or underlying kidney, cardiovascular, or pregnancy‑related conditions raises risk ^{[10] [9] [11]}.

7. How much is too much, and what guidance exists?

Regulatory and clinical sources note limited tolerance thresholds: the FDA‑referenced guidance cites maximum daily doses (about 200 mEq for younger adults and 100 mEq for those over 60), recommended short‑term use only, and advisories to avoid use beyond two weeks without medical supervision; nevertheless, severe toxicity has been reported after doses far above those limits ^{[9] [11] [3]}.

8. Context and competing narratives: safe common use versus documented harm

Public messaging often emphasizes that baking soda is a safe, inexpensive antacid and food ingredient, and many people tolerate recommended doses without incident; industry and safety summaries stress low toxicity under normal use ^{[8] [12]}. Clinical literature and poison‑center guidance counter that misuse—large single ingestions, chronic high intake, or use by high‑risk patients—has a clear record of serious adverse events and death ^{[4] [7] [5]}.

9. Practical takeaway for clinicians and consumers

Medical sources uniformly recommend limiting duration and dose, avoiding unsupervised chronic intake, watching for neurologic or cardiac symptoms, and seeking urgent care for suspected overdose; poison‑control and hospital case reports document specific emergency treatments and the spectrum of complications clinicians should expect ^{[11] [7] [4]}.