About Metabolic Acidosis

Chronic metabolic acidosis is a condition which occurs in a significant number of individuals who develop chronic kidney disease (CKD). Our body produces acid as part of daily functioning. This acid (which is different from stomach acid) is cleared by the kidneys. If kidney function declines, the acid can build up in the body and cause problems like accelerated progression of kidney disease, muscle wasting, bone disease, inflammation and malnutrition.

Correcting metabolic acidosis with sodium bicarbonate has been shown to delay the progression of kidney disease. For more information on the independent effect of bicarbonate therapy on the progression of chronic kidney disease please see the "Bicarbonate Case Studies" page. Correcting metabolic acidosis can also improve bone health and muscle strength. 1,2,3

Metabolic acidosis in chronic kidney disease is diagnosed with a routine blood test which is included as part of the kidney function panel or metabolic panel. The test is called “serum bicarbonate” or “total CO2”. The normal value of bicarbonate ranges between 23-29 meq/L. A serum bicarbonate of less than 22 meq/L in individuals with kidney disease is usually considered significant enough to require treatment with sodium bicarbonate.

Frequently Asked Questions

Click on any question to expand the answer

  • Each capsule of Bicarbi contains 650 mg of sodium bicarbonate in an enteric coated capsule. Bicarbi is used to treat metabolic acidosis or elevated blood acid levels. The acid in blood with metabolic acidosis is different from stomach acid. Elevated blood acid occurs when the body produces excessive quantities of acid or the kidneys aren't removing enough acid from the blood.
  • Yes, several studies have shown that improving low serum bicarbonate levels with sodium bicarbonate can slow the progression of kidney disease. 4,5 One study even showed not only did improving low serum bicarbonate level reduce the risk of kidney failure but it also improved the nutritional status of people with kidney disease.4 This said, raising low bicarbonate levels is only one part in improving outcomes for those with chronic kidney disease. Your health care provider will give you guidance on controlling blood pressure, controlling glucose, potential weight loss and some dietary requirements. All of these and more are modifiable factors in improving the outcome of chronic kidney disease or CKD. See 'References' in the 'About Metabolic Acidosis' section if you are interested in some of the published clinical data about improving bicarbonate levels in CKD.
  • Sodium bicarbonate is an acid buffer or a base. It is often used to treat metabolic acidosis. Sodium Bicarbonate is the same as baking soda used in cooking.
  • Metabolic acidosis is a condition that occurs when the body produces excessive quantities of acid or when the kidneys aren’t removing enough acid from the body. See the "About Metabolic Acidosis" section to learn more or to see clinical references. The acid elevated acid levels seen in metabolic acidosis are different from stomach acid.
  • Enteric coatings are designed to help capsules and tablets pass thru the acid environment of the stomach and not release the active ingredient of the until in the small intestine.
  • Bicarbi has an enteric coating so the sodium bicarbonate in Bicarbi won’t react with stomach acid. When un-coated sodium bicarbonate is taken, some of it reacts with the acid in the stomach and is lost and turned into carbon dioxide gas before it can enter the small intestine. When the bicarbonate is lost to carbon dioxide gas some potency is lost. The production of carbon dioxide gas from uncoated sodium bicarbonate reacting with stomach acid may also increase gastric discomfort, boating, belching or burping.
  • Your healthcare provider will guide you on your specific dosing for Bicarbi. The typical dose for Bicarbi is one capsule twice daily. Dosing can vary depending on your current needs. The need for bicarbonate supplementation and adjustment can change.
  • Resources where you can learn more about Metabolic Acidosis and Chronic Kidney disease include the NKF-National Kidney Foundation, the AAKP-American Association of Kidney Patients and UpToDate.


  1. Kraut JA, Madias NE. Metabolic Acidosis of CKD: An Update.
    Am J Kidney Dis. 2015 Oct 15
  2. Starke A, Corsenca A, Kohler T, Knubben J, Kraenzlin M, Uebelhart D, et al. Correction of metabolic acidosis with potassium citrate in renal transplant patients and its effect on bone quality.
    Clin J Am Soc Nephrol. 2012 Sep. 7(9):1461-72
  3. Abramowitz MK, Melamed ML, Bauer C, Raff AC, Hostetter TH. Effects of oral sodium bicarbonate in patients with CKD.
    Clin J Am Soc Nephrol. 2013 May. 8(5):714-20
  4. De Brito-Ashurst L, Varagunam M, Raferty J, Yaqoob M. Bicarbonate Supplementation Slows Progression of CKD and Improves Nutritional Status.
    J Am Soc Nephrol. 2009 , 20: 2075-2084
  5. Kovesdy CP, Anderson JE, Kalantar-Zadeh K. Association of serum bicarbonate levels with mortality in patients with non-dialysis dependent CKD.
    Nephrol Dial Tranplant 2009; 24:1232.