When is bicarbonate therapy indicated in metabolic acidosis?

Bicarbonate indicated: pH <7.10 in non-lactic metabolic acidosis (RTA, bicarbonate loss, hyperchloremic), severe hyperkalemia with acidosis, salicylate/TCA overdose (urinary alkalinization), rhabdomyolysis (urine alkalinization). Controversial/not routinely indicated: lactic acidosis (underlying cause must be treated; bicarbonate may worsen intracellular pH and increase CO2 production).

How is bicarbonate deficit calculated?

Bicarbonate deficit (mEq) = 0.5 x weight (kg) x (target HCO3 minus current HCO3). Administer 50% of calculated deficit over 4 to 8 hours, recheck blood gas. Target HCO3 for partial correction: 10 to 12 mEq/L (sufficient to raise pH >7.15 without overshooting). Overcorrection causes metabolic alkalosis, hypokalemia, hypocalcemia.

Bicarbonate Therapy pH Threshold Calculator

Determine sodium bicarbonate dose and pH threshold for administration in metabolic acidosis: typically reserved for pH <7.10 to 7.15 (lactic acidosis, DKA adjunct, RTA, toxin ingestion) with calculation of bicarbonate deficit.

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Bicarbonate Therapy pH Threshold Calculator

Frequently Asked Questions

When is bicarbonate therapy indicated in metabolic acidosis?

How is bicarbonate deficit calculated?