Get a month of TabletWise Pro for free! Click here to redeem

Bicarbonate Deficit

The bicarbonate deficit allows one to calculate the sodium bicarbonate deficit using body weight and an individual's sodium bicarbonate level. This is useful in diagnosis and replenishment of sodium bicarbonate.


Measured Factor
Bicarbonate deficit
Measured Factor Disease
  • Sodium bicabonate deficit
Measured Factor Detail
Bicarbonate works as a buffer in the body. A buffer reacts with both acids and bases to mitigate physiologic changes in pH. The body's pH can impact all body systems.
Body System
Multiple body systems
HCO3 deficit = 0.4 x Weight (kg) x [desired HCO3 (mmol/L)-measured HCO3 (mmol/L)]
Measured Factor Low Impact
  • Normal sodium bicarbonate
Measured Factor High Impact
  • Low sodium bicarbonate
An individual's weight and sodium bicarbonate level are plugged into the equation. The sodium bicarbonate level is found from a blood draw. Normal sodium bicarbonate is between 23 and 29 mEq/L. Ideal sodium bicarbonate used is 24 mEq/L.
  • N/A

Result Interpretation

Ranges Ranges
  • Critical Low: <23 mEq/L
  • Critical High: >30 mEq/L
  • Normal: 23-30 mEq/L
  • Normal Adult Male: N/A
  • Normal Adult Female: N/A
  • Normal Pediatric: N/A
  • Normal Neonate Female: N/A
  • Normal Geriatric Male: N/A
  • Normal Geriatric Female: N/A
Result Low Conditions
  • Metabolic acidosis
Result High Conditions
  • Metabolic alkalosis
False Positive
  • N/A
References: 2
Test Limitations
References: 2


Study Validation 1
Past studies have not focused on arterial blood gas alone to predict the severity of acute pancreatitis. Patients with acute pancreatitis presenting to a large hospital in North India between January 2012 to November 2013 were included in the prospective study. After an arterial blood gas analysis was done, the development of organ failure, interventions, and morality were recorded. 205 patients were included in the prospective study. Most subjects were males and between the age of 26 and 52 years old. Alcohol (n=93) and gall stone disease (n=73) caused a majority of these patients’ acute pancreatitis. A majority of the patients has organ failure (71.2%) and experienced local complications (83.9%). 18% of the subjects required interventions and 14.6% died. Patients with metabolic acidosis, a pH less than 7.35 (n=35), experienced organ failure more often, needed more interventions, and experienced increased mortality.
References: 3
Study Validation 2
The physiochemical approach is used to interpret acid-base balance in patients. While this has been extensively studied in critical care patients, this has not been studied much in emergency patients. Between March 2011 and September 2011 at the University Hospital of Heraklion, patients were enrolled in the study if an arterial blood gas was obtained while in the emergency department. The patient’s diagnosis and Sepsis-related Organ Failure Assessment was noted. Bicarbonate, base excess, and anion gap was calculated. Reference values were decided based on samples from 18 healthy volunteers. 365 patients were included in this study. A majority of the patients were males in their 70’s diagnosed with infection upon admission. Typically, bicarbonate, anion gap, and base excess are used to interpret the acid-base balance in a patient. The physiochemical approach compared to other methods identified significantly more patients with true metabolic acid-base disturbances.
References: 4
Study Validation 3
The study aimed to study risk factor associated with toxic epidermal necrolysis. This is a life-threatening disorder that involves necrosis of the skin. Between 2000 and 2006, all patients admitted to the National Taiwan University Hospital Burn Center with toxic epidermal necrolysis were included in the study. A variety of risk factors including base deficit were included. After interventions, patients were categorized as either a survivor (n=11) or a non-survivor (n=5). The mortality rate was 31.3%. Eleven risk factors were analyzed. Serum bicarbonate less than 20 millimoles per liter was the only risk factor that showed a statistically significant association with mortality in toxic epidermal necrolysis patients.
References: 5
Study Additional 1
Sodium bicarbonate correction in very low birth weight neonates remains controversial. The effect of sodium bicarbonate correction is not well understood. When metabolic acidosis occurs in neonates, interventions are taken. These interventions may include administering fluids, packed red blood cells, and/or vasopressors. 191 eligible neonates with a birth weight between 500 and 1250 grams were enrolled in the prospective, observational cohort study.   17 sodium bicarbonate corrections were given to 12 of these eligible neonates. When sodium bicarbonate was corrected in very low birth weight neonates during the first postnatal week, base deficits decreased and acidemia were corrected. However, no adverse effects or change in clinical status were seen by this intervention.
References: 6
Study Additional 2
Sodium bicarbonate has been used as a supplement during intense workouts to act as a buffer, prevent the body’s pH from fluctuating from normal, and thus prevent fatigue. This study aimed to study sodium bicarbonate’s effects maximal accumulated oxygen deficit. The maximal accumulated oxygen deficit was determined after 200 and 400 meter running performances on a treadmill. 15 male subjects were enrolled into the double-blind, crossover, placebo-controlled study. Both placebo and sodium bicarbonate were ingested in a capsule 90 minutes prior to the running performance. All subjects met the exhaustion criteria after the performances. Sodium bicarbonate showed to have a positive effect on maximal accumulated oxygen deficit.
References: 7


Gregory Schmidt
MD, University of Iowa


  1. Kurtz I. Acid-Base Case Studies. 2nd Ed. Trafford Publishing (2004); 68:150.
  2. N/A
  3. Sharma V, Shanti Devi T, Sharma R, Chhabra P, Gupta R, Rana SS, Bhasin DK. Arterial pH, bicarbonate levels and base deficit at presentation as markers of predicting mortality in acute pancreatitis: a single-centre prospective study.Gastroenterol Rep (Oxf). 2014 Aug;2(3):226-31.
  4. Antonogiannaki EM, Mitrouska I, Amargianitakis V, Georgopoulos D.Evaluation of acid-base status in patients admitted to ED-physicochemical vs traditional approaches.Am J Emerg Med. 2015 Mar;33(3):378-82.
  5. Yeong EK, Lee CH, Hu FC, M Z W. Serum bicarbonate as a marker to predict mortality in toxic epidermal necrolysis.J Intensive Care Med. 2011 Jul-Aug;26(4):250-4.
  6. Mintzer JP, Parvez B, Alpan G, LaGamma EF.Effects of sodium bicarbonate correction of metabolic acidosis on regional tissue oxygenation in very low birth weight neonates.J Perinatol. 2015 Aug;35(8):601-6.
  7. Brisola GM, Miyagi WE, da Silva HS, Zagatto AM.Sodium bicarbonate supplementation improved MAOD but is not correlated with 200- and 400-m running performances: a double-blind, crossover, and placebo-controlled study.Appl Physiol Nutr Metab. 2015 Sep;40(9):931-7.

Sign Up