From the Guidelines
Sodium bicarbonate tablets should be started when blood bicarbonate levels fall below 22 mmol/L, as this is the threshold at which metabolic acidosis can have significant adverse effects on the body, including increased protein degradation and decreased albumin synthesis 1. When considering the initiation of sodium bicarbonate therapy, it is crucial to assess the patient's overall clinical context, including the presence of chronic kidney disease or other conditions that may lead to metabolic acidosis.
- The goal of treatment is to maintain serum bicarbonate levels at or above 22 mmol/L, as recommended by the clinical practice guidelines for nutrition in chronic renal failure 1.
- The usual starting dose of sodium bicarbonate is 2 to 4 g/d or 25 to 50 mEq/d, which can be adjusted based on subsequent blood tests to achieve the desired bicarbonate level 1.
- Regular monitoring of blood electrolytes, including bicarbonate, sodium, and potassium levels, is necessary while on this treatment to avoid potential complications such as electrolyte imbalances.
- It is also important to consider the potential risks associated with sodium bicarbonate therapy, including the significant sodium content, which may be problematic for patients with heart failure, hypertension, or fluid retention 1.
From the Research
Blood Bicarbonate Levels and Sodium Bicarbonate Therapy
- The decision to start sodium bicarbonate tablets depends on the severity of metabolic acidosis and the patient's blood bicarbonate levels.
- According to 2, bicarbonate should be given at an arterial blood pH of ≤7.0, and the amount given should be calculated to bring the pH up to 7.2.
- However, 3 suggests that bicarbonate therapy has limited benefit for patients with severe metabolic acidosis (pH < 7.1 and bicarbonate < 6 mEq/L).
- 4 notes that metabolic acidosis is characterized by a primary reduction in serum bicarbonate concentration, and the calculation of the serum anion gap can aid in diagnosis.
- The use of sodium bicarbonate to treat metabolic acidosis is controversial, with some studies suggesting that it may not have a significant benefit in improving clinical outcomes or mortality rates 5, 6.
Guidelines for Sodium Bicarbonate Therapy
- Replacement of sodium bicarbonate may be useful for patients with sodium bicarbonate loss due to diarrhea or renal proximal tubular acidosis 6.
- For patients with acute metabolic acidosis, including diabetic ketoacidosis, lactic acidosis, septic shock, intraoperative metabolic acidosis, or cardiac arrest, there is no definite evidence that sodium bicarbonate administration is beneficial regarding clinical outcomes or mortality rate 6.
- Patients with advanced chronic kidney disease may benefit from sodium bicarbonate administration to attenuate the negative impact of metabolic acidosis on kidney dysfunction, but further evaluation is required to validate this strategy 6.