Sodium Hydroxide (NaOH): Medical Pros, Cons, and Conditions That Should Avoid Exposure

By SWA

Sodium hydroxide (NaOH), commonly known as lye or caustic soda, is a highly caustic and versatile chemical used in a wide range of industries, including food processing, cleaning, soap making, and pharmaceutical manufacturing. While sodium hydroxide is known for its dangerous corrosive properties, it is safely used in very controlled amounts in certain food production processes and medications. This article explores how sodium hydroxide is used in foods and pharmaceuticals, as well as the medical conditions that may warrant avoiding exposure.

Uses of Sodium Hydroxide in Food Production

In the food industry, sodium hydroxide serves primarily as a pH regulator, peeling agent, or processing aid. Its use is highly regulated, classified as E524 in food additives, and is considered safe when used in accordance with industry standards.

1. Pretzels

Sodium hydroxide is used to dip traditional soft pretzels before baking, giving them their characteristic dark brown crust and chewy texture. The lye bath helps trigger the Maillard reaction, which is responsible for the distinctive flavor and appearance of pretzels.
Learn more about the Maillard Reaction

2. Hominy and Nixtamalized Corn

Hominy and nixtamalized corn, used to make masa for tortillas and tamales, are processed using an alkaline solution, typically made with sodium hydroxide or calcium hydroxide. This softens the corn and increases its nutritional value by improving the bioavailability of niacin.
National Center for Biotechnology Information on Nixtamalization

3. Olives

Sodium hydroxide is used to cure olives, helping to remove their natural bitterness. The lye is thoroughly rinsed off before the olives are processed and made ready for consumption.
International Olive Council on Olive Processing

4. Chinese Century Eggs

Century eggs, a traditional Chinese delicacy, are preserved by soaking in a mixture containing sodium hydroxide. This changes the texture and flavor, turning the yolk creamy and the whites gelatinous.
Food Chemistry on Century Eggs

5. Cocoa Processing

In the Dutch process for making cocoa powder, sodium hydroxide or potassium carbonate is used to reduce the cocoa's acidity, darken its color, and improve its solubility, making it more suitable for baking and drinks.
Learn about the Dutch Process

6. Lutefisk

Lutefisk, a traditional Scandinavian dish, is made by soaking dried fish in a sodium hydroxide solution. This breaks down the fish’s proteins, giving it a gelatinous texture. The fish is then thoroughly rinsed to remove the lye before cooking.
Scandinavian Cultural Center on Lutefisk

Sodium Hydroxide in Medications

In the pharmaceutical industry, sodium hydroxide is used in small amounts as a pH adjuster or neutralizing agent. Its role is to help stabilize medications and ensure their effectiveness.

1. Omeprazole (Proton Pump Inhibitors)

Omeprazole, a commonly prescribed drug for acid reflux and GERD, contains sodium hydroxide to regulate its pH, ensuring the medication remains stable and effective.
Learn more about Omeprazole

2. Heparin Sodium Injections

Sodium hydroxide is used in some formulations of heparin sodium injections, which are anticoagulants used to prevent blood clots. The compound helps adjust the pH to ensure the drug's effectiveness.
NIH on Heparin

3. Acetaminophen (Paracetamol) IV Solutions

In some acetaminophen (paracetamol) intravenous (IV) formulations, sodium hydroxide is used to maintain the drug’s stability in liquid form, ensuring safe and effective delivery.
Learn more about IV Acetaminophen

4. Ketorolac Tromethamine Injections

Ketorolac tromethamine, a nonsteroidal anti-inflammatory drug (NSAID) used to treat moderate to severe pain, uses sodium hydroxide to adjust its pH for proper stability and delivery.
Learn more about Ketorolac

5. Adalimumab (Humira)

Adalimumab, used for autoimmune conditions like rheumatoid arthritis and Crohn’s disease, uses sodium hydroxide to balance the pH and ensure the stability of the biologic solution.
Humira FDA Information

6. Ondansetron (Zofran) Injections

In some formulations of ondansetron (Zofran) injections, sodium hydroxide is used to adjust the pH and ensure the anti-nausea medication remains effective, particularly for chemotherapy or surgical patients.
Zofran FDA Information

Medical Conditions That Should Avoid Sodium Hydroxide Exposure

While sodium hydroxide is safely used in controlled amounts in food and pharmaceuticals, its exposure can be harmful to individuals with certain pre-existing medical conditions. This section covers the conditions that make individuals more vulnerable to sodium hydroxide’s harmful effects.

1. Respiratory Conditions

  • Asthma: Sodium hydroxide fumes can trigger asthma attacks and exacerbate breathing difficulties.
    American Lung Association on Asthma

  • Chronic Obstructive Pulmonary Disease (COPD): Exposure to sodium hydroxide fumes can worsen respiratory complications in individuals with COPD.
    NHLBI on COPD

2. Skin Conditions

  • Eczema and Dermatitis: Sodium hydroxide is highly corrosive to the skin, and even small amounts can worsen conditions like eczema or dermatitis.
    National Eczema Association

  • Psoriasis: Sodium hydroxide can exacerbate psoriasis symptoms, causing further inflammation and increasing the risk of infections.
    NIH on Psoriasis

3. Eye Conditions

4. Gastrointestinal Conditions

  • Gastroesophageal Reflux Disease (GERD): If ingested, sodium hydroxide can cause severe esophageal burns, especially in individuals with weakened esophageal linings due to GERD.
    NIDDK on GERD

  • Peptic Ulcer Disease: Sodium hydroxide ingestion can further erode stomach linings in individuals with peptic ulcers, leading to perforation or internal bleeding.
    Cleveland Clinic on Peptic Ulcers

Safety Considerations

Although sodium hydroxide is used in food and pharmaceutical production, its application is carefully controlled to avoid harmful exposure. In the food industry, the lye is neutralized or thoroughly washed away before the product reaches the consumer. In pharmaceuticals, sodium hydroxide is used in small, regulated amounts to adjust pH levels and ensure the stability of the formulation.

Regulation and Guidelines

  • FDA: Sodium hydroxide is classified as GRAS (Generally Recognized as Safe) by the U.S. Food and Drug Administration (FDA) when used in accordance with good manufacturing practices.
    FDA GRAS Substances

  • EFSA: The European Food Safety Authority (EFSA) lists sodium hydroxide as E524, with strict regulations on its use in food products to ensure consumer safety.
    European Food Safety Authority (EFSA) Additive E524

Conclusion

While sodium hydroxide (NaOH) is a dangerous substance in uncontrolled amounts, its regulated use in food processing and pharmaceutical formulations is safe and beneficial. It plays a crucial role in improving food texture, flavor, and medication stability. However, individuals with certain medical conditions, such as respiratory disorders, skin diseases, or gastrointestinal problems, should take extra precautions to avoid sodium hydroxide exposure, particularly in industrial or household settings.

The safety of sodium hydroxide's use is ensured by stringent regulatory oversight from organizations like the FDA and EFSA. Proper precautions must always be followed in environments where sodium hydroxide is handled in its concentrated form.

References:

  1. FDA: GRAS Substances (Sodium Hydroxide)
  2. European Food Safety Authority (EFSA) Additive E524
  3. National Center for Biotechnology Information on Nixtamalization
  4. American Lung Association on Asthma
  5. National Eczema Association
  6. NIH on Psoriasis

 © 2000-2025 Sieglinde W. Alexander. All writings by Sieglinde W. Alexander have a fife year copy right.
Library of Congress Card Number: LCN 00-192742 ISBN: 0-9703195-0-9

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