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Bicarbonate – Function, Levels & Importance

Bicarbonate is a vital electrolyte in the blood that regulates the body's acid-base balance and acts as a natural buffer to maintain a stable blood pH.

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Things worth knowing about "Bicarbonate"

Bicarbonate is a vital electrolyte in the blood that regulates the body's acid-base balance and acts as a natural buffer to maintain a stable blood pH.

What is Bicarbonate?

Bicarbonate (chemical formula: HCO₃⁻), also known as hydrogen carbonate, is a negatively charged ion (anion) that plays a central role in regulating the acid-base balance of the human body. It is primarily formed through the reaction of carbon dioxide (CO₂) with water (H₂O) inside red blood cells. The body relies on bicarbonate as its most important buffer system to keep blood pH within the critical range of 7.35 to 7.45.

Biological Functions

Bicarbonate performs several essential functions in the human body:

Buffering: Bicarbonate neutralizes excess acids in the blood and tissues, preventing dangerous fluctuations in pH.
CO₂ Transport: Approximately 70% of the carbon dioxide carried in the blood is transported as bicarbonate from the tissues to the lungs, where it is exhaled.
Electrolyte Balance: As a major anion in blood plasma, bicarbonate contributes to maintaining osmotic balance and overall electrolyte homeostasis.
Digestion: The pancreas secretes bicarbonate-rich fluid into the small intestine to neutralize the acidic content arriving from the stomach and to create optimal conditions for digestive enzymes.

Reference Values and Measurement

Bicarbonate levels in the blood are measured as part of an arterial blood gas (ABG) analysis or a comprehensive metabolic panel. Normal bicarbonate values in arterial blood for adults range from 22 to 26 mmol/L. Deviations from these values may indicate disturbances in acid-base balance.

Elevated Bicarbonate Levels (Hyperbicarbonataemia)

A bicarbonate level above 26 mmol/L may indicate metabolic alkalosis. Common causes include:

Severe vomiting with loss of stomach acid
Excessive intake of antacids or sodium bicarbonate
Long-term use of diuretics (water pills)
Hyperaldosteronism (overproduction of the hormone aldosterone)

Low Bicarbonate Levels (Hypobicarbonataemia)

A bicarbonate level below 22 mmol/L may indicate metabolic acidosis. Frequent causes include:

Diabetic ketoacidosis
Kidney failure (reduced kidney function)
Severe diarrhoea with loss of bicarbonate
Lactic acidosis (increased lactic acid production, e.g., during shock)

Bicarbonate as a Supplement and Medication

Sodium bicarbonate (baking soda, NaHCO₃) is used both medically and in everyday life:

Medical use: Intravenous administration to treat severe metabolic acidosis, such as in cardiac arrest or poisoning.
Sports medicine: Oral supplementation as bicarbonate loading to temporarily enhance performance in high-intensity sports by improving lactic acid buffering capacity.
Antacid: Used as a remedy for heartburn and excess stomach acid.
Household use: Widely known as a leavening agent and home remedy.

Interactions and Safety Notes

Uncontrolled intake of sodium bicarbonate can lead to unwanted interactions and side effects:

Interactions with medications such as aspirin, certain antibiotics, and heart medications due to changes in urine pH
Excessive intake may cause milk-alkali syndrome (hypercalcaemia, alkalosis, kidney failure)
High sodium content may be problematic for individuals with high blood pressure or heart disease

References

World Health Organization (WHO): Electrolytes and Acid-Base Balance in Clinical Practice, WHO Technical Report, Geneva.
Berend, K., de Vries, A. P., Gans, R. O.: Physiological approach to assessment of acid-base disturbances. New England Journal of Medicine, 371(15), 1434-1445, 2014.
Kasper, D. L. et al.: Harrison's Principles of Internal Medicine, 20th Edition, McGraw-Hill Education, New York 2018.

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