Treatment of Low Bicarbonate (Hypobicarbonatemia)

Diagnostic Approach

• The American Journal of Kidney Diseases recommends measuring serum bicarbonate monthly in patients with chronic kidney disease (CKD) to determine the cause of low bicarbonate 1, 4

Treatment Algorithm

• The American Journal of Kidney Diseases suggests targeting a serum bicarbonate level of ≥22 mmol/L in patients with chronic kidney disease, with first-line treatment being oral sodium bicarbonate at 2-4 g/day (25-50 mEq/day) 1, 2, 3
• The American Journal of Kidney Diseases recommends monitoring serum bicarbonate monthly to adjust the dosage of oral sodium bicarbonate in patients with chronic kidney disease 1, 4
• Consider increasing dietary fruits and vegetables as an alternative to sodium bicarbonate supplementation, which provides additional benefits including decreased systolic blood pressure and weight reduction, as suggested by the American Journal of Kidney Diseases 5

Benefits of Correcting Acidemia

• Correction of metabolic acidosis provides multiple benefits, including decreased protein degradation rates, increased serum albumin levels, increased plasma concentrations of branched chain amino acids, improved body weight gain and mid-arm circumference, and reduced hospitalization in continuous peritoneal dialysis patients, according to the American Journal of Kidney Diseases 1, 2, 3

Cautions and Considerations

• The Intensive Care Medicine journal advises avoiding sodium bicarbonate for hypoperfusion-induced lactic acidosis with pH ≥7.15 6
• The Anaesthesia journal recommends using sodium bicarbonate with a low threshold to treat acidosis in malignant hyperthermia, as low pH values are associated with poor outcomes 7