Bicarbonate Therapy in Chronic Liver Disease

Introduction to Bicarbonate Management

• The American Journal of Kidney Diseases guidelines for bicarbonate management (targeting ≥22 mmol/L) apply to chronic kidney disease and dialysis patients, not chronic liver disease patients 1, 2, 3

Severe Acute Acidemia Management

• Administer intravenous sodium bicarbonate when arterial pH ≤7.0-7.1 with bicarbonate <10 mEq/L in the setting of acute decompensation or acute-on-chronic liver failure (ACLF) 4
• The goal of bicarbonate therapy is to raise pH to approximately 7.2, not to normalize it completely, in patients with severe acute acidemia 4
• The initial dose of sodium bicarbonate is 50 mmol (50 mL of 8.4% solution), with repeat arterial blood gas analysis to guide further therapy 4
• Overly rapid correction of acidemia can cause paradoxical CNS acidosis and cerebral edema 4