Bicarbonate Therapy in Metabolic Acidosis

Acid-Base Regulation

Normal serum bicarbonate levels should be maintained at or above 22 mmol/L, particularly in patients with chronic kidney disease or those undergoing maintenance dialysis, as recommended by the National Kidney Foundation 1

Correction of acidemia due to metabolic acidosis has been associated with increased serum albumin, decreased protein degradation rates, and increased plasma concentrations of branched chain amino acids and total essential amino acids, according to the American Journal of Kidney Diseases 1
Maintaining serum bicarbonate at or above 22 mmol/L should be a goal of management to prevent complications of acidemia in maintenance dialysis patients, as suggested by the National Kidney Foundation 1

Guidelines suggest against the use of sodium bicarbonate therapy to improve hemodynamics or reduce vasopressor requirements in patients with hypoperfusion-induced lactic acidemia with pH ≥ 7.15, as recommended by the Society of Critical Care Medicine 2, 3
Bicarbonate administration has been associated with sodium and fluid overload, increased lactate and PaCO2, and decreased serum ionized calcium, according to the Society of Critical Care Medicine 2, 3

Acidemia due to metabolic acidosis is associated with increased oxidation of branched chain amino acids, increased protein degradation, and decreased albumin synthesis, as reported by the American Journal of Kidney Diseases 1
Correction of acidemia can increase cellular influx and decrease cellular efflux of branched chain amino acids, promoting greater body weight gain and increased mid-arm circumference, according to the American Journal of Kidney Diseases 1

Oral sodium bicarbonate at 2-4 g/day (25-50 mEq/day) can effectively increase serum bicarbonate concentrations in chronic kidney disease patients, as recommended by the National Kidney Foundation 1