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Alkali Therapy (Metabolic Acidosis / CKD-Related Acidosis)

Sodium Bicarbonate

Brand names: Various — tablets 500 mg, oral solution, IV infusion 1.26% / 4.2% / 8.4%

Oral sodium bicarbonate used in chronic kidney disease to correct the metabolic acidosis that accompanies declining renal function. This is the renal-replacement-of-base context rather than acute resuscitation use.

Dosing — being independently re-sourced

ClinCalc Pro is rebuilding its dose data from primary open sources — the manufacturer SmPC (eMC), the WHO Model Formulary and other official references — under clinician review. This drug's structured dose is not yet published here. Confirm all doses against the product SmPC and your local formulary before prescribing.

Clinical monograph

How it works

Bicarbonate acts as an alkalinising base, buffering retained hydrogen ions and raising serum bicarbonate towards the normal range. Correcting acidosis is thought to slow muscle catabolism and bone demineralisation seen in CKD.

Prescribing in practice

  • Each gram delivers a substantial sodium load, so it can worsen fluid retention, oedema and hypertension in CKD and heart failure — use cautiously and review volume status.
  • Titrate against serum bicarbonate aiming for the low-normal range rather than over-correction, which risks metabolic alkalosis and hypokalaemia.
  • Separate dosing from other medicines where the rise in gastric and urinary pH could alter absorption, and review concurrently with diuretic and antihypertensive therapy.

Monitoring

Monitor serum bicarbonate, potassium, blood pressure and fluid status, adjusting the dose to maintain bicarbonate within target.

Counselling the patient

  • Take regularly as prescribed to keep your blood acid level steady.
  • Report new ankle swelling, breathlessness or rapid weight gain.
  • Do not double up if a dose is missed.

Evidence & guidelines

NICE CKD guidance and trial data support oral bicarbonate to correct chronic metabolic acidosis and may help preserve renal function, though optimal targets remain debated.

Reference: NICE NG203 (CKD); Cooper et al. Lancet 2020 (BICARBONATE trial); de Brito-Ashurst et al. JASN 2009; ALS Guidelines 2021; Drug verified in RxNorm (NLM); confirm dosing against the manufacturer SPC (eMC). Verify against your local formulary and current prescribing references before prescribing. Monograph status: clinician-reviewed (2026-07-04).

Related

Curated clinical cross-links plus same-class fallbacks.

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