From the FDA Drug Label
Plasma concentration is regulated by the kidney through acidification of the urine when there is a deficit or by alkalinization of the urine when there is an excess. Bicarbonate (HCO3-) is a normal constituent of body fluids and the normal plasma level ranges from 24 to 31 mEq/liter
A bicarbonate level of 14 mEq/L is below the normal range of 24 to 31 mEq/L. With an anion gap (AG) of 16 mEq/L, which is elevated, this indicates the presence of an acidosis with an increased anion gap. The low bicarbonate level suggests a metabolic acidosis. The elevated anion gap suggests that the acidosis is due to the accumulation of unmeasured anions. 1
From the Research
A bicarbonate level of 14 mEq/L with an anion gap of 16 mEq/L indicates a high anion gap metabolic acidosis, which requires prompt medical evaluation to identify and treat the underlying cause, as suggested by the most recent study 2. This finding suggests a significant acid-base disturbance, with a substantial decrease in bicarbonate levels from the normal range of 22-26 mEq/L, and an elevated anion gap above the normal range of 8-12 mEq/L. The combination of low bicarbonate and high anion gap points to excess acid accumulation in the body, which can occur due to several conditions, including:
- Diabetic ketoacidosis
- Lactic acidosis
- Kidney failure
- Certain poisonings, such as methanol, ethylene glycol, or salicylates
- Severe diarrhea with starvation Management depends on identifying and treating the underlying cause while supporting the patient's acid-base balance, as outlined in the study 3. Initial steps may include:
- Intravenous fluids
- Insulin if ketoacidosis is present
- Antibiotics for sepsis-induced lactic acidosis
- Hemodialysis for certain toxin ingestions or severe kidney failure The body normally maintains acid-base balance through respiratory and renal compensation mechanisms, but when these are overwhelmed, metabolic acidosis develops, potentially causing symptoms like rapid breathing, confusion, fatigue, and in severe cases, cardiac arrhythmias or shock, as discussed in the study 4. It is essential to calculate the delta anion gap/delta bicarbonate ratio, as suggested in the study 2, to detect coexisting acid-base disorders in patients with high anion gap metabolic acidosis. The use of individual baseline values for anion gap and serum bicarbonate, rather than mean normal values, can help avoid misdiagnosis of complex acid-base disorders and ensure appropriate treatment, as highlighted in the study 2.