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Bicarbonate – Function, Levels & Importance

Bicarbonate is an essential electrolyte in the human body that regulates the acid-base balance and is found in blood and tissues.

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Things worth knowing about "Bicarbonate"

Bicarbonate is an essential electrolyte in the human body that regulates the acid-base balance and is found in blood and tissues.

What is Bicarbonate?

Bicarbonate (chemical formula: HCO3³) is a negatively charged ion (anion) that plays a central role in regulating the acid-base balance of the human body. It is formed when carbon dioxide (CO2) dissolves in the blood and reacts with water. In everyday life, bicarbonate is also found in mineral waters and as sodium bicarbonate (baking soda) in food and medicine.

Biological Functions

In the body, bicarbonate is the most important buffer system of the blood. It keeps blood pH stable within a narrow range of 7.35 to 7.45, which is essential for the proper functioning of enzymes, hormones, and cells.

Buffering action: Bicarbonate neutralizes excess acids in the blood, preventing dangerous acidification (acidosis).
Carbon dioxide transport: Approximately 70% of the carbon dioxide transported in the blood is carried from the tissues to the lungs in the form of bicarbonate, where it is exhaled.
Kidney function: The kidneys actively regulate bicarbonate levels by reabsorbing or excreting bicarbonate to control long-term acid-base balance.
Digestion: The pancreas produces bicarbonate-rich fluid that neutralizes acidic stomach contents in the small intestine.

Reference Values and Natural Sources

In blood serum, the normal bicarbonate level is 22 to 26 mmol/l. In clinical diagnostics, bicarbonate levels are commonly measured as part of a blood gas analysis (BGA). Bicarbonate occurs naturally in many mineral waters and is also used as a dietary supplement and medication.

Disorders of Bicarbonate Balance

Acidosis (Excess Acid in the Blood)

A too-low bicarbonate level in the blood leads to metabolic acidosis. Causes can include kidney disease, diabetic ketoacidosis, severe diarrhea, or poisoning. Symptoms include rapid breathing, confusion, and fatigue.

Alkalosis (Excess Base in the Blood)

A too-high bicarbonate level leads to metabolic alkalosis. This can be triggered by prolonged vomiting, excessive use of antacids, or certain kidney disorders. Symptoms may include muscle cramps, tingling, and cardiac arrhythmias.

Medical Applications

Sodium bicarbonate is used in a variety of medical contexts:

Treatment of acidosis: Intravenous administration of sodium bicarbonate solution to correct severe metabolic acidosis.
Antacid: As a stomach remedy for short-term neutralization of excess gastric acid in cases of heartburn.
Dialysis: Used as a buffering agent during hemodialysis in patients with kidney disease.
Sports medicine: Sodium bicarbonate is discussed in sports medicine as a performance-enhancing agent, as it can buffer lactic acidosis in the muscles.

Bicarbonate in Food and Mineral Water

Many mineral waters are naturally rich in bicarbonate (over 600 mg/l) and are considered particularly effective at balancing excess acidity. As sodium bicarbonate (E500), it is also an approved food additive used as a leavening agent or acidity regulator. Targeted intake via bicarbonate-rich mineral water can be beneficial for people with increased acid production, such as those engaged in intensive exercise or following specific diets.

Diagnosis and Measurement

Bicarbonate levels in the blood are routinely determined via arterial or venous blood gas analysis. The so-called standard bicarbonate is also frequently measured as part of a comprehensive metabolic panel or electrolyte panel. Deviations provide important clues about disorders of the kidneys, lungs, or metabolism.

References

World Health Organization (WHO): Guidelines for Drinking-water Quality, 4th Edition. Geneva: WHO Press, 2011.
Kasper, D.L. et al. (Eds.): Harrison's Principles of Internal Medicine, 21st Edition. New York: McGraw-Hill, 2022.
Rose, B.D. & Post, T.W.: Clinical Physiology of Acid-Base and Electrolyte Disorders, 5th Edition. New York: McGraw-Hill, 2001.

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