Potassium bicarbonate powder dosage

Potassium Bicarbonate Supplementation

The risk of many troublesome—even deadly—health problems can be reduced with a good diet and increased by a bad one. Our diet has changed radically from what our ancestors ate 50,000 years ago, and not all of these changes have been for the good. Our modern diets are likely to contain far less potassium, far more sodium, more acid forming nutrients, and less base forming nutrients than those enjoyed by our ancestors when our species evolved. Fortunately, an inexpensive potassium bicarbonate dietary supplement can help you to eat more like a Caveman without all that Stone Age food hunting and gathering work.

As we discuss below, potassium bicarbonate can do a lot more for you than help regulate your blood pressure. Studies of potassium supplements in humans have reported:

  1. Reduced Blood Pressure
  2. Increased Muscle Mass
  3. Decreased Bone Loss
  4. Reduced Risk of Stroke
  5. Improved Endothelial Function
  6. Reduced Dietary Acid Load

Most Americans Do Not Get Enough Potassium

Modern human dietary requirements were encoded into our DNA during evolution starting with the Paleolithic diet, which contained about 35% meat and about 65% plant foods. The type of meat (more monounsaturated, less saturated fat) and of plant foods (more omega-3 fatty acids and far more fiber) eaten by early man was different as well.

One of the most important differences was that there was far more potassium (from fruits and vegetables) and much less acid-forming content (because of the increased ratio of plant to animal foods) in the early human diet. The change to a low potassium, high acid-forming content diet has had a profound impact on many aspects of wellness and healthy aging, including those listed above.

Nothing in biology makes sense except in the light of evolution. —Theodosius Dobzhansky . . . modern DNA is a coded description of the environments in which ancestors survived. A survival manual is handed down the generations. —Richard Dawkins, A Genetic Book of the Dead

Much Higher Potassium Content in Paleolithic Diet

According to one study,1 “the Stone Age human potassium intake averaged 400 ± 125 mEq/d , which exceeds the NHANES III age-grouped averages (~60-85 mEq/d) by factors greater than 4.” This amount also “exceeds the 120 mEq/d set for adequate intake by the Food and Nutrition Board of the Institute of Medicine in 2004 and 2006 and the same value, 120 mEq/d recommended by the U.S. Department of Agriculture in 2005 .”1 Note that the potassium content of the average American adult diet is only 50% to 70% of the amount recommended. This means that most American diets are officially deficient in potassium. Worse yet, we believe that the official RDA is too low.

Much Lower Sodium Content in Paleolithic Diet

The Paleolithic diet contained much lower levels of sodium than our modern diet, typically only a fraction of a gram per day. By comparison, our modern diet contains far more sodium, about 2.5 to 5 grams of sodium per day.10 This means that the ratio of potassium to sodium in our diet has changed from about 5 to about 0.7, a change toward less potassium and more sodium of 700%. Our kidneys are not evolved to deal with such a radically changed dietary ratio of potassium to sodium, and may be losing too much potassium and retaining too much sodium with potentially serious adverse health consequences, such as some cases of hypertension.

Much Lower Acid Formation from the Paleolithic Diet

The Institute of Medicine also reported that “. . . Fruits and vegetables, particularly leafy greens, vine fruit and root vegetables, are good sources of potassium and bicarbonate precursors. Although meat, milk and cereal products contain potassium, they do not contain enough bicarbonate precursors to balance their acid-forming precursors, such as sulfur-containing amino acids.” The results of a high net-acid producing diet include1 increased urinary calcium excretion, increased bone resorption markers (indicative of bone loss), and increased urinary nitrogen excretion (negative nitrogen balance as occurs with loss of lean body mass).

Reduction of Stroke Risk by Potassium

One paper reported on the potassium dietary intake (estimated from a 24 hour recall of dietary foods) versus occurrence of stroke during a 12-year follow-up of 356 men and 503 women who were 50 to 79 years old at baseline and without pre-existing history of heart attack, heart failure, or stroke.2 The results showed that the relative risks of stroke-associated mortality in the lowest tertile of potassium intake, as compared with that in the top two tertiles combined, were 2.6 (p=0.16) in men and 4.8 (p=0.01) in women. The effect was partially independent of known cardiovascular risk factors, such as age, sex, blood pressure, blood cholesterol levels, obesity, fasting blood glucose levels, and cigarette smoking.

Another study3 of 5,600 men and women older than 65 years and who were free of strokes, followed for 4 to 8 years, reported that a lower serum potassium level was associated with an increased relative risk of stroke (RR:1.5, p<0.005); a lower serum potassium level in those taking diuretics (presumably for high blood pressure) was associated with an even greater increased risk of stroke (RR:2.5, p<0.0001). In fact, “for each SD decrease in serum potassium in a diuretic user, there was a 38% increase in the RR for stroke. For each SD decrease in dietary potassium in a nondiuretic user, there was an 18% increase in the RR for stroke.”3

A Possible Mechanism for Increased Stroke Damage As a Result of a High Acid Diet

One interesting relationship between increased tissue acid level and stroke was reported in the Sept. 17, 2004 Cell.4 Researchers found that the acidosis (increase in tissue acid) that results from ischemia (reduced oxygen availability)-induced increase in anaerobic glycolysis (the production of energy via a non-oxygen requiring glucose pathway) worsens ischemic brain injury, such as in stroke. These scientists found that knocking out the ASICs (acid-sensing ion channels) that detect the acidosis provided neuroprotective effect against excitotoxic damage in knockout mouse neurons, as compared to neurons of wild-type mice. In fact, they found that the area of killed brain tissue (infarct) was about 60% less in strokes induced in the ASIC knockouts as compared to wild type mice.

It would be interesting to see whether, using the same model, potassium bicarbonate could produce a similar neuroprotective effect by reducing tissue acidosis itself, which should also reduce the activation of acid-sensing ion channels.

Alkaline Diets Favor Lean Tissue Mass in Older Adult Humans

Chronic metabolic acidosis can result from eating a diet whose metabolism yields acids (such as sulfuric acid) in excess of bases (e.g., bicarbonate). In fact, this type of diet is typically consumed by populations of industrially developed (Westernized) countries, where animal foods rich in acid precursors are consumed disproportionally to that of plant foods rich in base precursors.5 One result of chronic metabolic acidosis is an acceleration in the protein degradation of skeletal muscle; moreover, diet-dependent metabolic acidosis tends to increase in severity with age.5 One recent study6 reported that increased potassium urinary excretion (derived from alkaline potassium salts found in dietary fruits and vegetables) was associated with increased lean body mass in 384 men and women 65 or older who participated in a calcium and vitamin D versus placebo study of osteoporosis. The authors concluded that “. . . subjects with a potassium intake of 134 mmol/d can expect to have 1.64 kg more lean tissue mass than subjects with half that potassium intake.”5

In a separate paper,6 researchers studying the effect of an oral potassium bicarbonate supplement (60–120 mmol/day for 18 days) in 14 healthy postmenopausal women found that the supplements reduced urinary nitrogen excretion, an indicator of preserved lean body mass. The authors concluded that “he magnitude of the KHCO3-induced nitrogen sparing effect is potentially sufficient to both prevent continuing age-related loss of muscle mass and restore previously accrued deficits.” The amount of potassium bicarbonate supplement used in this study was 6 to 12 grams per day, which supplied 2.34 to 4.68 grams of potassium per day.

Decreased Calcium Excretion Helps Protect Bones

In another paper,7 the effect of potassium bicarbonate on calcium excretion in postmenopausal women was reported. The authors note that potassium bicarbonate has been shown to potently reduce urine calcium excretion in adult humans, including patients with hypertension or calcium urolithiasis, and postmenopausal women. As the authors note, “he diet-induced low-grade metabolic acidosis that persists further contributes to the external losses of calcium by direct impairment of renal calcium reabsorptive efficiency, a characteristic of metabolic acidosis.” They, therefore, studied the effect of 30, 60, or 90 mmol/d potassium bicarbonate treatment in 170 postmenopausal women for up to 36 months. (3, 6, or 9 grams per day of potassium bicarbonate supplying 1.17, 2.34, or 3.51 grams per day of potassium, respectively.)

All doses of potassium bicarbonate reduced urinary calcium excretion throughout the study. Interestingly, in the 28% of the subjects that had high baseline urinary calcium excretion, 60 mmol/day of potassium bicarbonate decreased the urinary calcium excretion by an amount that, over a 36 month period, would accumulate up to 55,845 mg of calcium or nearly 5% of bone calcium content.7

Potassium is Vasoactive, Increasing Blood Flow, Helping Regulate Blood Pressure

It has been reported that potassium depletion in normal humans increases blood pressure, as well as reducing the ability to deal with an acute sodium load and sodium retention.8 In borderline hypertensives (140/90), “a low-potassium diet (16 mmol/day) for 10 days increases systolic and diastolic pressures by 7 and 6 mmHg, respectively, relative to 10 days on a high-potassium diet (96 mmol/day).”8 Indeed, potassium supplementation lowers blood pressure in established hypertension.

“Potassium is vasoactive; when infused into the arterial supply of a vascular bed, blood flow increases.”8 Potassium release is regulated by the Na+-K+-ATPase into the sympathetic nerve terminals, leaving less in the cleft. This also promotes relaxation of the vascular smooth muscle and increases blood flow.” In this way, potassium acts importantly to regulate the excitatory effects of norepinephrine. In one study,9 reduced dietary potassium reversibly enhanced vasopressor (vascular contraction, which induces increased blood pressure) response to stress in African Americans. As noted in the paper, the blood pressure of normotensive blacks is much more likely to be salt sensitive than that of normotensive whites. “In normotensive blacks but not whites , a marginally reduced dietary intake of potassium reversibly enhances adrenergically mediated vasopressor responsiveness to stress.”

How to Take Potassium Bicarbonate

You can easily eat more like a Caveman without having to become a hunter/gatherer by taking one or two capsules, each containing 1.35 grams of potassium bicarbonate (13.5 meq or 527 mg potassium) two to four times per day. Take with meals.11

If you are an adult eating a typical American diet, you would need approximately 3 to 4 capsules per day of potassium bicarbonate to increase your total potassium intake to the RDA.

WARNING: IF YOU ARE TAKING A POTASSIUM-SPARING DIURETIC PRESCRIPTION DRUG DO NOT TAKE SUPPLEMENTAL POTASSIUM!

  1. Sebastian et al. The evolution-informed optimal dietary potassium intake of human beings greatly exceeds current and recommended intakes. Semin Nephrol 26:447-53 (2006).
  2. Khaw et al. Dietary potassium and stroke-associated mortality. N Engl J Med 316:235-40 (1987).
  3. Green et al. Serum potassium level and dietary potassium intake as risk factors for stroke. Neurology 59:314-20 (2002).
  4. Xiong et al. Neuroprotection in ischemia: blocking calcium-permeable acid-sensing ion channels. Cell 118:687-96 (2004).
  5. Dawson-Hughes et al. Alkaline diets favor lean tissue mass in older adults. Am J Clin Nutr 87:662-5 (2008).
  6. Frassetto et al. Potassium bicarbonate reduces urinary nitrogen excretion in postmenopausal women. J Clin Endocrinol Metab 82:254-59 (1997).
  7. Frassetto et al. Long-term persistence of the urine calcium-lowering effect of potassium bicarbonate in postmenopausal women. J Clin Endocrinol Metab 90:831-4 (2005).
  8. Haddy et al. Role of potassium in regulating blood flow and blood pressure. Am J Physiol Regul Integr Comp Physiol 290:R546-52 (2006).
  9. Sudhir et al. Reduced dietary potassium reversibly enhances vasopressor response to stress in African Americans. Hypertension 29:1083-90 (1997).
  10. Alaimo et al. Daily Intake of vitamins, minerals, and fiber of persons aged two months and over in the United States: Third National Health And Nutrition Survey, Phase 1, 1988-91. Adv Data 258:1-28 (1994).
  11. Frassetto L, Morris RC Jr, Sebastian A. Long-term persistence of the urine calcium-lowering effect of potassium bicarbonate in postmenopausal women. J Clin Endocrinol Metab 2005 Feb;90(2):831-4

©2009 by Durk Pearson & Sandy Shaw

Effect of Short-Term Supplementation of Potassium Chloride and Potassium Citrate on Blood Pressure in Hypertensives

Much evidence suggests that potassium intake plays an important role in regulating blood pressure.1,2 Clinical trials of potassium supplementation have shown a significant blood pressure-lowering effect, particularly in individuals with high blood pressure.3,4 However, most previous trials have used chloride salt of potassium (ie, potassium chloride), which is convenient for making the study double-blinded using Slow-K (slow-release potassium chloride) versus Slow-K placebo.5 Potassium in fruits and vegetables is not a chloride salt, but rather a mixture of potassium phosphate, sulfate, citrate, and many organic anions including proteins. It is unclear whether a nonchloride salt of potassium has a greater or lesser effect on blood pressure compared with potassium chloride.

A number of studies have shown that increasing the consumption of fruits and vegetables has a significant effect on blood pressure.6,7 A comparison of the DASH (Dietary Approaches to Stop Hypertension) study to clinical trials of potassium chloride supplementation5 seems to indicate that the decline in blood pressure with increasing fruits and vegetables is similar to that found when it is performed by supplementing potassium chloride in individuals with elevated blood pressure. To further study the effect of different potassium salts on blood pressure, we carried out a randomized crossover trial comparing potassium chloride with potassium citrate.

Methods

Fourteen individuals with essential hypertension (systolic ≥140 mm Hg and/or diastolic ≥90 mm Hg) referred by local general practitioners entered and completed the study. Patients had not received previous treatment or treatment had been stopped for at least 4 weeks or 8 weeks for patients using diuretics before the study. We excluded individuals with secondary cause of hypertension, malignant hypertension, renal failure, ischemic heart disease, cerebrovascular disease, pregnancy, diabetes mellitus, or those who were using oral contraceptives or any other drugs. The study was approved by the local hospital ethics committee. All subjects gave written informed consent. There were 11 men (9 white) and 3 women (2 white). Mean age was 51±9 years and average body mass index was 29.9±5.0 (kg/m2).

The study was designed as a randomized crossover study. After baseline assessments, which included blood pressure, body weight, plasma and urinary electrolytes, individuals were randomized to receive either potassium chloride, 96 mmol/d (12 Slow-K tablets), or potassium citrate, 96 mmol/d (34 mL potassium citrate liquid). After 1 week on this treatment, individuals then crossed over to receive the other treatment for 1 additional week. There was a 1-week washout between the 2 treatment periods. All subjects were advised to maintain their dietary habits and lifestyle, and to avoid intense physical exercise throughout the study. Blood pressure was measured in the same arm using an automatic digital blood pressure monitor (Omron HEM-705CP) after 5-minute rest in sitting position.8 Three readings of blood pressure were taken at 1- to 2-minute intervals and the mean of 3 readings was used in the data analysis. Two 24-hour urine collections were obtained at entry to the study, after 1 week on potassium chloride and after 1 week on potassium citrate.

Results are reported as mean±SD. Paired t tests were used to compare the difference in continuous variables between 2 study periods. Statistical analyses were performed using Statistical Package for Social Science.

Results

At baseline, blood pressure was 151±16/93±7 mm Hg with a 24-hour urinary potassium excretion of 81±24 mmol. During the randomized crossover part of the study, blood pressure was 140±12/88±7 mm Hg with a 24-hour urinary potassium of 164±36 mmol on day 7 of potassium chloride, and blood pressure was 138±12/88±6 mm Hg with a 24-hour urinary potassium of 160±33 mmol on day 7 of potassium citrate. These blood pressures were significantly lower compared with that at baseline; however, there was no significant difference in blood pressure between potassium chloride and potassium citrate (Figure; mean difference: 95% confidence interval, 1.6; range, −2.3 to 5.6 mm Hg; P=0.385 for systolic; range, −2.4 to 3.7 mm Hg; P=0.653 for diastolic blood pressure).

Blood pressure and 24-hour urinary potassium excretion at baseline, on day 7 of potassium chloride, and on day 7 of potassium citrate in 14 patients with essential hypertension.

Plasma potassium was 4.2±0.3 mmol/L at baseline. During the randomized crossover part of the study, plasma potassium was 4.6±0.3 mmol/L with potassium chloride and 4.6±0.3 mmol/L with potassium citrate. These values were significantly higher compared with that at baseline (increased by 0.4 mmol/L); however, there was no significant difference between potassium chloride and potassium citrate in plasma potassium (Table). Plasma bicarbonate was significantly higher with potassium citrate compared with that with potassium chloride. With potassium citrate, there was a significant reduction in 24-hour urinary calcium and calcium/creatinine ratio, and a significant increase in urine pH, compared with that with potassium chloride or at baseline. There was no significant difference between potassium chloride and potassium citrate in pulse rate, or body weight, or plasma sodium, chloride, calcium, phosphate, creatinine, or 24-hour urinary volume, sodium, or creatinine excretion. These values were not significantly different from those at baseline either (Table).

There was no significant difference between potassium chloride and potassium citrate in plasma renin activity or aldosterone; however, plasma aldosterone was significantly higher with both potassium chloride and potassium citrate compared with that at baseline (Table). The 24-hour urinary noradrenaline or adrenaline was not significantly different between potassium chloride and potassium citrate, whereas urinary noradrenaline/creatinine ratio was significantly lower with potassium citrate compared with that with potassium chloride. Both 24-hour urinary dopamine and dopamine/creatinine ratio were significantly lower with potassium citrate compared with that with potassium chloride. However, none of the urinary catecholamines was significantly different from those at baseline (Table).

Discussion

Many previous randomized trials have shown that potassium chloride supplementation lowers blood pressure,3,4 and it has been suggested that potassium chloride should be used for potassium replacement in clinical practice.9 Our study suggests that potassium citrate has a similar effect on blood pressure as potassium chloride, indicating that potassium ion may have an effect on blood pressure independent of its conjugate anions. These results suggest that potassium does not need to be given with chloride for a blood pressure-lowering effect and an increase in the consumption of foods high in potassium, although not in the form of potassium chloride, may have a similar effect on blood pressure as potassium chloride supplementation.

Unlike most of the previous potassium supplementation trials,3 which were performed in individuals with a low potassium intake, eg, 60 mmol/d on average, our study was in individuals with a relatively high potassium intake as indicated by a baseline 24-hour urinary potassium excretion of 81 mmol. The results suggest that increasing potassium intake has a significant effect on blood pressure in these individuals.

Our finding that potassium chloride and potassium citrate have a similar effect on blood pressure is supported by the DASH study.6 In the DASH study, an increase in the consumption of fruits and vegetables with an increase in 24-hour urinary potassium caused a decline in blood pressure of 7/3 mm Hg in individuals with mildly elevated blood pressure.6 This decrease in blood pressure is similar to that found in a carefully controlled double-blind study of potassium chloride supplementation in hypertensive individuals.5 Our results are also supported by the study by Morris et al, who compared potassium bicarbonate with potassium chloride, and showed that these 2 potassium salts were equally effective in lowering blood pressure in individuals with high blood pressure.10 However, our finding is in contrast with the study by Overlack et al,11 who studied the effect of potassium chloride 120 mmol/d for 8 weeks and potassium citrate 120 mmol/d for 8 weeks in 25 patients with essential hypertension. They found a significant decline in blood pressure with potassium citrate, but no significant change in blood pressure with potassium chloride. The latter observation contrasted with most of the potassium chloride supplementation trials in hypertensive individuals.3,4 Another study by Mullen and O’Connor compared potassium chloride with potassium citrate in 24 normotensive individuals and showed that neither potassium salt had any significant effect on blood pressure.12 It is likely that this study is underpowered to detect a small change in blood pressure with potassium supplementation in normotensive individuals.

Our study also showed that potassium citrate had a significant effect on reducing urinary calcium and calcium/creatinine ratio. This is consistent with other studies that showed that a higher potassium intake was associated with a lower urinary calcium excretion and a higher bone mass.13–16 Because acid–base homeostasis also influences urinary calcium excretion and different potassium salts have different effects on acid–base balance, it is difficult to know whether the change in urinary calcium observed in the studies of potassium supplementation is caused by the change in potassium or acid–base balance. A number of studies by Lemann et al17–19 suggest that the effect of potassium on urinary calcium excretion may be independent of its effect on acid–base balance, but by giving a potassium salt as a citrate or bicarbonate, there is a greater effect in reducing urinary calcium and calcium/creatinine ratio compared with potassium chloride. From our study, it is unclear whether potassium ion has an independent effect on urinary calcium. The fact that with potassium chloride there was no significant change in urinary calcium or calcium/creatinine ratio but a decrease in urine pH would suggest that the effect of potassium, if anything, might be mitigated by the change in pH.

In our study, urinary dopamine excretion was significantly decreased with potassium citrate compared with that with potassium chloride. This is in agreement with the findings by Ball et al20 who showed a decrease in urinary dopamine after oral sodium bicarbonate and an increase in urine dopamine with oral sodium, potassium, or ammonium chloride. A common mechanism is the alkalosis induced by potassium citrate or sodium bicarbonate and the alkalosis may reduce renal dopamine production. However, it is unclear how far the change in urinary dopamine would influence the effect of potassium on blood pressure.

The potential limitations of our study include: (1) the study was not double-blinded; however, the use of automatic digital blood pressure monitor could have eliminated the observer bias in the blood pressure measurement; (2) there was no placebo-controlled period; therefore, the placebo effect cannot be ruled out. (Interpretation of changes from baseline should be performed cautiously because of the potential for regression to the mean, especially for blood pressure because the trial enrolled persons with elevated blood pressure.); and (3) The number of individuals studied is small. With the sample size of 14, the study has a power of 90% to detect a difference of 5.9 mm Hg or more in systolic blood pressure between potassium chloride and potassium citrate, and a power of 80% to detect a difference of 5.1 mm Hg or more in systolic blood pressure, given a standard deviation of the difference of 6.8. A difference of 5 to 6 mm Hg in systolic blood pressure would be considered clinically significant. However, our study would be underpowered to detect a difference in systolic blood pressure of <5.1 mm Hg, which would be considered important from a population viewpoint. In view of these potential limitations, a larger double-blind placebo-controlled trial with a longer duration is underway to further study the effect of different potassium salts on blood pressure and also to study whether increasing potassium intake has other beneficial effects on human health,2 as suggested by epidemiological studies in humans and experimental studies in animals.

In conclusion, our study suggests that in patients with essential hypertension, potassium chloride and potassium citrate have a similar effect on blood pressure. These results support other evidence for an increase in potassium intake and indicate that potassium does not need to be given in the form of potassium chloride to lower blood pressure. Increasing the consumption of foods high in potassium is likely to have the same effect on blood pressure as potassium chloride.

Perspectives

Many randomized trials have shown that potassium chloride supplementation lowers blood pressure. However, potassium in fruits and vegetables is not a chloride salt, but a mixture of potassium phosphate, sulfate, citrate, and many organic anions including proteins. Our study suggests that a nonchloride salt of potassium (potassium citrate) has a similar effect on blood pressure as potassium chloride. These results support other evidence for an increase in potassium intake and this would best be performed by an increase in fruit and vegetable consumption, which in themselves may have other beneficial effects on health independent of potassium intake.

We thank Lawrence Ruddock for double-checking the data of this study. We also thank other staff of the Blood Pressure Unit, including clinicians, scientists, and technicians, for help with the study. We are grateful to Alliance Pharmaceuticals Ltd for providing Slow-K.

Footnotes

Correspondence to G. A. MacGregor, Blood Pressure Unit, St. George’s Hospital Medical School, Cranmer Terrace, London, SW17 0RE, UK. E-mail

  • 1 He FJ, MacGregor GA. Potassium intake and blood pressure. Editorial. Am J Hypertens. 1999; 12: 849–851.CrossrefMedlineGoogle Scholar
  • 2 He FJ, MacGregor GA. Beneficial effects of potassium. Clinical Review. BMJ. 2001; 323: 497–501.CrossrefMedlineGoogle Scholar
  • 3 Whelton PK, He J, Cutler JA, Brancati FL, Appel LJ, Follmann D, Klag MJ. Effects of oral potassium on blood pressure, meta-analysis of randomised controlled clinical trials. JAMA. 1997; 277: 1624–1632.CrossrefMedlineGoogle Scholar
  • 4 Cappuccio FP, MacGregor GA. Does potassium supplementation lower blood pressure? A meta-analysis of published trials. J Hypertens. 1991; 9: 465–473.CrossrefMedlineGoogle Scholar
  • 5 MacGregor GA, Smith SJ, Markandu ND, Banks R, Sagnella GA. Moderate potassium supplementation in essential hypertension. Lancet. 1982; II: 567–570.Google Scholar
  • 6 Appel LJ, Moore TJ, Obarzanek E, Vollmer WM, Svetkey L, Sacks FM, Bray GA, Vogt TM, Cutler JA, Windhauser MM, Lin PH, Karanja N. A clinical trial of the effects of dietary patterns on blood pressure. N Engl J Med. 1997; 336: 1117–1124.CrossrefMedlineGoogle Scholar
  • 7 John JH, Ziebland S, Yudkin P, Roe LS, Neil HAW, for the Oxford Fruit and Vegetable Study Group. Effects of fruit and vegetable consumption on plasma antioxidant concentrations and blood pressure: a randomised controlled trial. Lancet. 2002; 359: 1969–1974.CrossrefMedlineGoogle Scholar
  • 8 O’Brien E, Mee F, Atkins N, Thomas M. Evaluation of three devices for self-measurement of blood pressure according to the revised British Hypertension Society Protocol: the Omron HEM-705CP, Philips HP5332, and Nissei DS-175. Blood Pressure Monitoring. 1996; 1: 55–61.MedlineGoogle Scholar
  • 9 Cohn JN, Kowey PK, Whelton PK, Prisant M. New guidelines for potassium replacement in clinical practice. A contemporary review by the National Council on Potassium in Clinical Practice. Arch Intern Med. 2000; 160: 2429–2436.CrossrefMedlineGoogle Scholar
  • 10 Morris RC Jr., Schmidlin O, Tanaka M, Forman A, Frassetto L, Sebastian A. Differing effects of supplemental KCl and KHCO3: pathophysiological and clinical implications. Semin Nephrol. 1999; 19: 487–493.MedlineGoogle Scholar
  • 11 Overlack A, Maus B, Ruppert M, Lennarz M, Kolloch R, Stumpe KO. Potassium citrate versus potassium chloride in essential hypertension. Effects on hemodynamic, hormonal and metabolic parameters. Dtsch Med Wochenschr. 1995; 120: 631–635.MedlineGoogle Scholar
  • 12 Mullen JT, O’Connor DT. Potassium effect on blood pressure: is the conjugate anion important? J Human Hypertens. 1990; 4: 589–596.MedlineGoogle Scholar
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Why Your Bottled Water Contains Four Different Ingredients

Next time you reach for a bottle of water on store shelves, take a look at the ingredient list. You’re likely to find that it includes more than just water.

Popular bottled water brand Dasani, for example, lists magnesium sulfate, potassium chloride, and salt alongside purified water on its Nutrition Facts label. SmartWater contains calcium chloride, magnesium chloride, and potassium bicarbonate. Nestle Pure Life’s list includes calcium chloride, sodium bicarbonate, and magnesium sulfate. And these are just a few brands. Bottled water companies are purifying water, but then they’re adding extra ingredients back.

None of this should be cause for health concerns, says Marion Nestle, professor of Nutrition, Food Studies, and Public Health and professor of Sociology at New York University. The additives being put into water are those naturally found in water and the quantities of these additives are likely too small to be of much significance. “If you had pure water by itself, it doesn’t have any taste,” says Bob Mahler, Soil Science and Water Quality professor at the University of Idaho. “So companies that sell bottled water will put in calcium, magnesium or maybe a little bit of salt.”

Taste tests have revealed that many people find distilled water to taste flat as opposed to spring waters, which can taste a bit sweet. Minerals offer a “slightly salty or bitter flavors,” which is likely why low mineral soft waters have a more appealing taste, Nestle wrote in her book What To Eat.

Many of the ingredients that are added to bottled water occur naturally in tap water and in our daily diets. Potassium chloride, for example, is a chemical compound that is often used as a supplement for potassium, which benefits heart health and aids normal muscular and digestive functions. Magnesium chloride, magnesium sulfate, and calcium chloride are all inorganic salts.

The U.S. Food and Drug Administration (FDA) recommends that Americans reduce current levels of sodium intake by 2,300 mg per day, so you would have to drink a lot of water to make much of a difference, Nestle says. The typical amount of sodium in water averages at around 17 mg per liter.

But just because additives are generally naturally occurring ingredients doesn’t mean that consumers shouldn’t look at labels. If labels show calories, that means sugars have been added. Some bottled waters can be high in sodium, and the Environmental Protection Agency (EPA) recommends only drinking water that contains 20 mg of sodium per liter or less.

The best choice that many water consumers can make may be to just stick to drinking tap water. “To the extent that tap water is clean and free of harmful contaminants,” says Nestle, “it beats everything in taste and cost.”

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Potassium bicarbonate

Medically reviewed by Drugs.com on Dec 5, 2019 – Written by Cerner Multum

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What is potassium bicarbonate?

Potassium is a mineral that is found naturally in foods and is necessary for many normal functions of your body, especially the beating of your heart.

Potassium bicarbonate is used to prevent or to treat a potassium deficiency (hypokalemia).

Potassium bicarbonate may also be used for other purposes not listed in this medication guide.

Important Information

Avoid taking potassium supplements or using other products that contain potassium without first asking your doctor. Salt substitutes or low-salt dietary products often contain potassium. If you take certain products together you may accidentally get too much potassium. Read the label of any other medicine you are using to see if it contains potassium.

There are many other medicines that can interact with potassium bicarbonate. Tell your doctor about all the prescription and over-the-counter medications you use. This includes vitamins, minerals, herbal products, and drugs prescribed by other doctors. Do not start using a new medication without telling your doctor. Keep a list with you of all the medicines you use and show this list to any doctor or other healthcare provider who treats you.

Before taking this medicine

Before taking this medication, tell your doctor if you are allergic to any drugs, or if you have:

  • kidney disease;

  • Addison’s disease;

  • stomach ulcer or an intestinal blockage; or

  • chronic diarrhea (colitis).

If you have any of these conditions, you may not be able to use potassium bicarbonate, or you may need a dose adjustment or special tests during treatment.

FDA pregnancy category C. This medication may be harmful to an unborn baby. Tell your doctor if you are pregnant or plan to become pregnant during treatment.

It is not known whether potassium bicarbonate passes into breast milk or if it could harm a nursing baby. Do not use this medication without telling your doctor if you are breast-feeding a baby.

How should I take potassium bicarbonate?

Use this medication exactly as directed on the label, or as prescribed by your doctor. Do not use it in larger amounts or for longer than recommended.

Take each dose with a full glass of water.

Take potassium bicarbonate with food or milk to lessen stomach upset.

Drop the effervescent tablets into a glass of water (at least 4 ounces, or one-half cup). Allow the tablets to dissolve completely and then drink this mixture right away. Do not save it for later use.

Do not stop taking this medication without first talking to your doctor. If you stop taking potassium bicarbonate suddenly, your condition may become worse.

Store potassium bicarbonate at room temperature away from moisture and heat.

What happens if I miss a dose?

Take the missed dose as soon as you remember. If you are more than 2 hours late in taking your medicine, skip the missed dose and wait until your next regularly scheduled dose. Do not take extra medicine to make up the missed dose.

What happens if I overdose?

Seek emergency medical attention if you think you have used too much of potassium bicarbonate.

Overdose symptoms may include numbness or tingling in your hands or feet, uneven heart rate, paralysis, feeling like you might pass out, chest pain or heavy feeling, pain spreading to the arm or shoulder, nausea, sweating, general ill feeling, or seizure (convulsions).

What should I avoid while taking potassium bicarbonate?

Avoid taking potassium supplements or using other products that contain potassium without first asking your doctor. Salt substitutes or low-salt dietary products often contain potassium. If you take certain products together you may accidentally get too much potassium. Read the label of any other medicine you are using to see if it contains potassium.

Potassium bicarbonate side effects

Get emergency medical help if you have any of these signs of an allergic reaction: hives; difficulty breathing; swelling of your face, lips, tongue, or throat.

Stop using potassium bicarbonate and call your doctor at once if you have any of these serious side effects:

  • confusion;

  • uneven heartbeat;

  • unusual tiredness, weakness, heavy feeling in your legs;

  • severe stomach pain cramping; or

  • black, bloody, or tarry stools.

Less serious side effects may include:

  • nausea, vomiting, diarrhea, or upset stomach;

  • a rash;

  • slight tingling in the hands or feet; or

  • anxiety.

This is not a complete list of side effects and others may occur. Tell your doctor about any unusual or bothersome side effect. You may report side effects to FDA at 1-800-FDA-1088.

What other drugs will affect potassium bicarbonate?

The following drugs can interact with potassium bicarbonate. Tell your doctor if you are using any of these:

This list is not complete and there may be other drugs that can interact with potassium bicarbonate or affect your condition. Tell your doctor about all your prescription and over-the-counter medications, vitamins, minerals, herbal products, and drugs prescribed by other doctors. Do not start a new medication without telling your doctor.

Further information

Remember, keep this and all other medicines out of the reach of children, never share your medicines with others, and use this medication only for the indication prescribed.

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.

Copyright 1996-2018 Cerner Multum, Inc. Version: 4.04.

Medical Disclaimer

More about potassium bicarbonate

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  • Drug class: minerals and electrolytes

Consumer resources

  • Potassium Bicarbonate Capsules and Tablets

Other brands: Effervescent Potassium, K-Effervescent, K-vescent, Quick-K

Related treatment guides

  • Hypokalemia
  • Prevention of Hypokalemia

OVERVIEW

Potassium bicarbonate (poe-TAS-ee-yum buy-KAR-bo-nate) is a colorless crystalline solid or white powder with no odor and a salty taste. It occurs naturally in salt beds, sea water, silicate rocks, and a number of foods, primarily fruits and vegetables. Potassium bicarbonate is also present in the tissues of humans and other animals, where it is involved in a number of essential biological processes, including digestion, muscle contraction, and heartbeat. It is used primarily in cooking and baking, as a food additive, and in fire extinguishers.

HOW IT IS MADE

Potassium bicarbonate is made by passing carbon dioxide gas through an aqueous solution of potassium carbonate: K2CO3 + CO2 + H2O → 2KHCO3

KEY FACTS

OTHER NAMES:

Potassium acid carbonate; potassium hydrogen carbonate

FORMULA:

KHCO3

ELEMENTS:

Potassium, hydrogen, carbon, oxygen

COMPOUND TYPE:

Acid salt (inorganic)

STATE:

Solid

MOLECULAR WEIGHT:

100.12 g/mol

MELTING POINT:

decomposes above 100°C (212°F)

BOILING POINT:

Not applicable

SOLUBILITY:

Soluble in water; insoluble in ethyl alcohol

COMMON USES AND POTENTIAL HAZARDS

One of the most familiar applications of potassium bicarbonate is as an antacid to treat the symptoms of upset stomach. The compound reacts with stomach acid—hydrochloric acid; HCl—to relieve gaseous distress, stomach pain, and heartburn. The compound can also be used to treat potassium deficiency in the body. Some research suggests that potassium bicarbonate may help restore muscle and bone tissue, particularly in women with the degenerative bone disease osteoporosis. The compound is also used as a food additive, as a leavening agent, to maintain proper acidity in foods, to supply potassium to a diet, and to provide the bubble and fizz in carbonated drinks.

Potassium bicarbonate is also used in certain types of fire extinguishers. When such an extinguisher is used, the potassium bicarbonate reacts with an acid present in the device to produce carbon dioxide. The carbon dioxide propels a liquid from the extinguisher and, itself, helps put out a fire. Potassium bicarbonate is also used in agriculture to maintain proper acidity in soils and to supply potassium that may be missing from the ground.

Under normal circumstances, potassium bicarbonate poses no health threat to humans. Excess potassium in the body may result in a condition known as hyperkalemia, characterized by tingling of the hands and feet, muscle weakness, and temporary paralysis. Such a condition is very rare when potassium bicarbonate is used in normal amounts.

Interesting Facts

Potassium bicarbonate can be substituted for baking soda (sodium bicarbonate; NaHCO3) for people who are on a low-sodium diet.

FOR FURTHER INFORMATION

Rowley, Brian. “Fizzle or Sizzle? Potassium Bicarbonate Could Help Spare Muscle and Bone.” Muscle & Fitness (December 2002): 72.

“Strong Muscle and Bones.” Prevention (June 1, 1995): 70-73.

See AlsoSodium Bicarbonate

Identification

Are you a new drug developer? Contact us to learn more about our customized products and solutions. Stay in the know! As part of our commitment to providing the most up-to-date drug information, we will be releasing #DrugBankUpdates with our newly added curated drug pages. #DrugBankUpdates Name Potassium bicarbonate Accession Number DB11098 Type Small Molecule Groups Approved Description

Potassium bicarbonate is a white, crystalline, slightly alkaline and salty substance. It is produced by the passage of carbon dioxide through an aqueous potassium carbonate solution. It is used in medicine as an antacid.3 It is registered in the FDA under the section of suitable, safe and effective ingredients for OTC antacids.7 This FDA denomination classifies potassium bicarbonate as a GRAS ingredient.8

Structure Download Similar Structures

Structure for Potassium bicarbonate (DB11098)

× Close Synonyms

  • Carbonic acid, monopotassium salt
  • Potassium hydrogen carbonate

External IDs E-501(II) / INS NO.501(II) / INS-501(II) Active Moieties

Name Kind UNII CAS InChI Key
Potassium cation ionic 295O53K152 24203-36-9 NPYPAHLBTDXSSS-UHFFFAOYSA-N

Prescription Products

Name Dosage Strength Route Labeller Marketing Start Marketing End
Unlock Additional Data
Effer-K 10 mEq Cherry Vanilla Tablet, effervescent 391 mg/1 Oral Nomax Inc. 2013-01-30 Not applicable US
Effer-K 10 mEq Unflavored Tablet, effervescent 391 mg/1 Oral Nomax Inc. 2013-01-30 Not applicable US
Effer-K 20 mEq Orange Cream Tablet, effervescent 782 mg/1 Oral Nomax Inc. 2013-01-30 Not applicable US
Effer-K 20 mEq Unflavored Tablet, effervescent 782 mg/1 Oral Nomax Inc. 2013-01-30 Not applicable US
Effer-K Cherry Berry Tablet, effervescent 977.5 mg/1 Oral Nomax Inc. 2013-01-30 Not applicable US
Effer-K Lemon Citrus Tablet, effervescent 977.5 mg/1 Oral Nomax Inc. 2013-01-30 Not applicable US
Effer-K Orange Tablet, effervescent 977.5 mg/1 Oral Nomax Inc. 2013-01-30 Not applicable US
Effer-K Unflavored Tablet, effervescent 977.5 mg/1 Oral Nomax Inc. 2013-01-30 Not applicable US
K-effervescent Tablet, effervescent 25 meq/1 Oral Qualitest 2006-01-06 Not applicable US
K-Vescent Efffervescent Tablet, effervescent 25 meq/1 Oral Cardinal Health 2005-04-22 2018-04-30 US

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  • Product Code Product Code

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Mixture Products Unapproved/Other Products

Name Ingredients Dosage Route Labeller Marketing Start Marketing End
Effer-K 10 mEq Cherry Vanilla Potassium bicarbonate (391 mg/1) Tablet, effervescent Oral Nomax Inc. 2013-01-30 Not applicable US
Effer-K 10 mEq Unflavored Potassium bicarbonate (391 mg/1) Tablet, effervescent Oral Nomax Inc. 2013-01-30 Not applicable US
Effer-K 20 mEq Orange Cream Potassium bicarbonate (782 mg/1) Tablet, effervescent Oral Nomax Inc. 2013-01-30 Not applicable US
Effer-K 20 mEq Unflavored Potassium bicarbonate (782 mg/1) Tablet, effervescent Oral Nomax Inc. 2013-01-30 Not applicable US
Effer-K Cherry Berry Potassium bicarbonate (977.5 mg/1) Tablet, effervescent Oral Nomax Inc. 2013-01-30 Not applicable US
Effer-K Lemon Citrus Potassium bicarbonate (977.5 mg/1) Tablet, effervescent Oral Nomax Inc. 2013-01-30 Not applicable US
Effer-K Orange Potassium bicarbonate (977.5 mg/1) Tablet, effervescent Oral Nomax Inc. 2013-01-30 Not applicable US
Effer-K Unflavored Potassium bicarbonate (977.5 mg/1) Tablet, effervescent Oral Nomax Inc. 2013-01-30 Not applicable US
Effervescent Potassium Chloride Potassium bicarbonate (0.7 g/1) + L-Lysine hydrochloride (1.5 g/1) + Potassium chloride (1.25 g/1) Tablet, effervescent Oral Qualitest 2006-01-06 2021-07-31 US
K-effervescent Potassium bicarbonate (25 meq/1) Tablet, effervescent Oral Qualitest 2006-01-06 Not applicable US

Categories UNII HM5Z15LEBN CAS number 298-14-6 Weight Average: 100.1151
Monoisotopic: 99.956275759 Chemical Formula CHKO3 InChI Key TYJJADVDDVDEDZ-UHFFFAOYSA-M InChI InChI=1S/CH2O3.K/c2-1(3)4;/h(H2,2,3,4);/q;+1/p-1 IUPAC Name potassium hydrogen carbonate SMILES .OC()=O

Pharmacology

Indication

Potassium bicarbonate is used as an antacid, electrolyte replenisher and potassium supplement. It can also be used as an excipient in drug formulations.8 An antacid is a medication used to neutralize gastric acid in a short timeframe after ingestion and the effect is soon overcome by meal-stimulated acid secretion.1

Pharmacodynamics

Potassium is the principal intracellular cation in most body tissues. The concentration of potassium ions is essential to conduct nerve impulses in specialized tissues like brain, heart and skeletal muscle, as well as to maintain normal renal function, acid-base balance, and cellular metabolic functions.9 The use of compounds containing bicarbonate is showed to produce the release of CO2. This effect has been one of the problems of the use of potassium bicarbonate as it can cause eructation.5

Mechanism of action

The antacid potential of potassium bicarbonate is attained by increasing the gastrointestinal pH by neutralizing hydrochloric acid.6 The increase in pH results in suppression of the action of pepsin which is the enzyme that exacerbates ulceration due to the presence of acid.5

Target Actions Organism
AHydrogen ions neutralizer

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Learn more Absorption

Potassium bicarbonate intake is done mainly in the small intestine in which approximately 90% of the potassium will be absorbed by passive diffusion.2

Volume of distribution Not Available Protein binding Not Available Metabolism Not Available Route of elimination

Approximately 90% of the exogenous potassium consumed is lost in the urine while the other 10% is excreted in feces and a very small amount can be found in the sweat. The excreted potassium is freely filtered by the glomerulus of the kidney.2

Half life

Some reports have shown that after absorption, most body potassium exchanges rapidly with a half-life of less than 7 hours.2

Clearance Not Available Toxicity

Potassium bicarbonate does not contain any toxic chemicals and it is not listed as a carcinogenic or a potential carcinogen.8 Potassium bicarbonate is also considered safe in pregnancy as the current data do not suggest a teratogenic potential or any developmental toxicity.4

Affected organisms

  • Humans and other mammals

Pathways Not Available Pharmacogenomic Effects/ADRs Not Available

Interactions

Drug Interactions This information should not be interpreted without the help of a healthcare provider. If you believe you are experiencing an interaction, contact a healthcare provider immediately. The absence of an interaction does not necessarily mean no interactions exist.

  • All Drugs
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  • Vet approved
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  • Withdrawn
  • Investigational
  • Experimental
Drug Interaction
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Abacavir Abacavir may decrease the excretion rate of Potassium bicarbonate which could result in a higher serum level.
Acarbose Acarbose may decrease the excretion rate of Potassium bicarbonate which could result in a higher serum level.
Acebutolol The risk or severity of hyperkalemia can be increased when Acebutolol is combined with Potassium bicarbonate.
Aceclofenac Aceclofenac may decrease the excretion rate of Potassium bicarbonate which could result in a higher serum level.
Acemetacin Acemetacin may decrease the excretion rate of Potassium bicarbonate which could result in a higher serum level.
Acetaminophen Acetaminophen may decrease the excretion rate of Potassium bicarbonate which could result in a higher serum level.
Acetazolamide Acetazolamide may increase the excretion rate of Potassium bicarbonate which could result in a lower serum level and potentially a reduction in efficacy.
Acetylsalicylic acid Acetylsalicylic acid may decrease the excretion rate of Potassium bicarbonate which could result in a higher serum level.
Aclidinium Aclidinium may decrease the excretion rate of Potassium bicarbonate which could result in a higher serum level.
Acrivastine Acrivastine may decrease the excretion rate of Potassium bicarbonate which could result in a higher serum level.

Additional Data Available

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    Extended description of the mechanism of action and particular properties of each drug interaction.

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Food Interactions Not Available General References External Links KEGG Compound C18606 PubChem Compound 516893 PubChem Substance 347827895 ChemSpider 55053 ChEBI 81862 ChEMBL CHEMBL2106975 Wikipedia Potassium_bicarbonate ATC Codes A12BA04 — Potassium hydrogencarbonate

  • A12BA — Potassium
  • A12B — POTASSIUM
  • A12 — MINERAL SUPPLEMENTS
  • A — ALIMENTARY TRACT AND METABOLISM

MSDS (108 KB)

Clinical Trials

Clinical Trials

Phase Status Purpose Conditions Count
2, 3 Recruiting Treatment Cystine renal calculi 1
3 Recruiting Prevention Distal Renal Tubular Acidosis 1

Pharmacoeconomics

Manufacturers Not Available Packagers Not Available Dosage forms

Form Route Strength
Tablet, effervescent Oral
Capsule Oral
Tablet Oral
Tablet, effervescent Oral 391 mg/1
Tablet, effervescent Oral 782 mg/1
Tablet, effervescent Oral 977.5 mg/1
Granule, effervescent Oral
Powder Oral
Tablet, effervescent Oral 978 mg/1
Liquid Oral
Tablet, effervescent Oral 25 meq/1

Prices Not Available Patents Not Available

Properties

State Solid Experimental Properties

Property Value Source
melting point (°C) Decomposes before melting ‘MSDS’
water solubility Soluble Stedman’s Medical Dictionary. (2002)
pKa 6.37 ‘MSDS’

Predicted Properties

Property Value Source
Water Solubility 681.0 mg/mL ALOGPS
logP -0.08 ALOGPS
logP 0.25 ChemAxon
logS 0.83 ALOGPS
pKa (Strongest Acidic) 6.05 ChemAxon
Physiological Charge -1 ChemAxon
Hydrogen Acceptor Count 3 ChemAxon
Hydrogen Donor Count 1 ChemAxon
Polar Surface Area 60.36 Å2 ChemAxon
Rotatable Bond Count 0 ChemAxon
Refractivity 20.34 m3·mol-1 ChemAxon
Polarizability 3.86 Å3 ChemAxon
Number of Rings 0 ChemAxon
Bioavailability 1 ChemAxon
Rule of Five Yes ChemAxon
Ghose Filter No ChemAxon
Veber’s Rule No ChemAxon
MDDR-like Rule No ChemAxon

Predicted ADMET features Not Available

Spectra

Mass Spec (NIST) Not Available Spectra

Spectrum Spectrum Type Splash Key
Predicted GC-MS Spectrum – GC-MS Predicted GC-MS Not Available

Taxonomy

Description This compound belongs to the class of organic compounds known as organic carbonic acids. These are compounds comprising the carbonic acid functional group. Kingdom Organic compounds Super Class Organic acids and derivatives Class Organic carbonic acids and derivatives Sub Class Organic carbonic acids Direct Parent Organic carbonic acids Alternative Parents Carbonate salts / Organic potassium salts / Organic oxides / Hydrocarbon derivatives / Carbonyl compounds Substituents Carbonate salt / Carbonic acid / Organic alkali metal salt / Organic oxygen compound / Organic oxide / Hydrocarbon derivative / Organic potassium salt / Organic salt / Organooxygen compound / Carbonyl group Molecular Framework Aliphatic acyclic compounds External Descriptors potassium salt, organic salt (CHEBI:81862)

Targets

Details1. Hydrogen ions Kind Small molecule Organism Not Available Pharmacological action Yes Actions Neutralizer

Transporters

Kind Protein Organism Humans Pharmacological action No Actions Substrate General Function Sodium:potassium:chloride symporter activity Specific Function Electrically silent transporter system. Mediates sodium and chloride reabsorption. Plays a vital role in the regulation of ionic balance and cell volume. Gene Name SLC12A2 Uniprot ID P55011 Uniprot Name Solute carrier family 12 member 2 Molecular Weight 131445.825 Da

  1. Haas M: The Na-K-Cl cotransporters. Am J Physiol. 1994 Oct;267(4 Pt 1):C869-85. doi: 10.1152/ajpcell.1994.267.4.C869.

Kind Protein Organism Humans Pharmacological action No Actions Substrate General Function Sodium:potassium:chloride symporter activity Specific Function Electrically silent transporter system. Mediates sodium and chloride reabsorption. Plays a vital role in the regulation of ionic balance and cell volume. Gene Name SLC12A1 Uniprot ID Q13621 Uniprot Name Solute carrier family 12 member 1 Molecular Weight 121449.13 Da

  1. Haas M: The Na-K-Cl cotransporters. Am J Physiol. 1994 Oct;267(4 Pt 1):C869-85. doi: 10.1152/ajpcell.1994.267.4.C869.

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Drug created on December 03, 2015 09:51 / Updated on February 02, 2020 02:27

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