Estimate bicarbonate replacement for metabolic acidosis.
Clinical Constants
kg
mEq/L
mEq/L
Replacement Estimate
Bicarb Deficit245mEq
Ampules (50mEq)4.9AmpsSodium Bicarb
Administer half, then reassess.
Clinical Note
About this calculator
Overview
The bicarbonate deficit formula provides an estimate of the amount of sodium bicarbonate required to increase the serum bicarbonate level to a desired target in patients with severe metabolic acidosis. It assumes a distribution space for bicarbonate of roughly 50% of total body weight.
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Pro Tips
A common target is to raise bicarbonate to 15 mEq/L or a pH of 7.2, rather than full correction to 24 mEq/L.
Administer the first half of the calculated deficit and then recheck the blood gas.
Monitor for fluid overload, as sodium bicarbonate therapy provides a significant sodium load.
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Fun Facts
"Sodium bicarbonate therapy is controversial in lactic acidosis and DKA; it is usually reserved for pH < 7.1."
"Rapid correction of acidosis can lead to paradoxical intracellular acidosis and hypokalemia."
"One ampule of standard sodium bicarbonate (50 mL of 8.4%) contains 50 mEq."
"The distribution space may increase to 0.8 L/kg in severe acidosis (metabolic 'sink')."
