Bicarbonate Deficit and Replacement
Estimates the bicarbonate deficit in metabolic acidosis from weight and current bicarbonate.
When to use
Severe metabolic acidosis when bicarbonate replacement is considered, always with monitoring and treatment of the cause.
Pearls and pitfalls
- The formula uses a distribution volume of 0.5 L/kg and a bicarbonate target of 24 mmol/L.
- The calculated deficit is an estimate and should not be replaced at once without monitoring.
- Bicarbonate replacement does not replace treatment of the cause of acidosis.
- In lactic acidosis and ketoacidosis, clinical response and cause determine the indication.
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Formula
Bicarbonate deficit (mEq) = 0.5 × weight (kg) × (24 − current bicarbonate in mmol/L).
Evidence
Deficit estimate used in severe acidosis management, described in a review of life-threatening acid-base disorders.
References
- Adrogue HJ, Madias NE. Management of life-threatening acid-base disorders. Second of two parts. N Engl J Med. 1998;338(2):107-111. doi:10.1056/NEJM199801083380207
Frequently asked questions
What is Bicarbonate Deficit and Replacement?
Estimates the bicarbonate deficit in metabolic acidosis from weight and current bicarbonate. Severe metabolic acidosis when bicarbonate replacement is considered, always with monitoring and treatment of the cause.
How is the result calculated?
Bicarbonate deficit (mEq) = 0.5 × weight (kg) × (24 − current bicarbonate in mmol/L).
How should the result be interpreted?
Deficit estimate used in severe acidosis management, described in a review of life-threatening acid-base disorders.
What are the sources?
Adrogue HJ, Madias NE. Management of life-threatening acid-base disorders. Second of two parts. N Engl J Med. 1998;338(2):107-111.