What agent is most commonly used to correct metabolic acidosis and how is administered?

Updated: Dec 08, 2020
  • Author: Christie P Thomas, MBBS, FRCP, FASN, FAHA; Chief Editor: Vecihi Batuman, MD, FASN  more...
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Sodium bicarbonate (NaHCO3) is the agent most commonly used to correct metabolic acidosis. The HCO3- deficit can be calculated by using the following equation:

HCO3- deficit = deficit/L (desired serum HCO3- - measured HCO3-) × 0.5 × body weight (volume of distribution for HCO3-)

This provides a crude estimate of the amount of HCO3- that must be administered to correct the metabolic acidosis; the serum HCO3- level or pH should be reassessed frequently.

HCO3- can be administered intravenously to raise the serum HCO3- level adequately to increase the pH to greater than 7.20. Further correction depends on the individual situation and may not be indicated if the underlying process is treatable or the patient is asymptomatic.

This is especially true in certain forms of metabolic acidosis. For example, in high anion gap acidosis secondary to accumulation of organic acids, lactate, and ketones, these anions are eventually metabolized to HCO3-. When the underlying disorder is treated, the serum pH corrects; thus, caution should be exercised in these patients when providing alkali to raise the pH much higher than 7.20, because an overshoot alkalosis may occur.

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