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Bicarbonate Overcorrection CKD — ESENeph MCQ

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ModerateAcid-BaseBicarbonate Overcorrection CKDESENeph

A 55-year-old man with CKD G4 has a serum bicarbonate of 14 mmol/L. He starts oral sodium bicarbonate 1 g TDS as per KDIGO 2024 recommendation. After 6 weeks, his bicarbonate is 28 mmol/L (above upper limit of normal). What adjustment is needed?

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Correct answer: A — Reduce sodium bicarbonate dose – KDIGO warns against exceeding the upper limit of normal bicarbonate

KDIGO 2024 practice point 3.10.2 specifically warns to monitor treatment to ensure it does not result in serum bicarbonate concentrations exceeding the upper limit of normal. Overcorrection can cause metabolic alkalosis, which may worsen hypertension (sodium load), promote tissue calcification, and cause paradoxical intracellular acidosis. The dose should be reduced to maintain bicarbonate within the normal range (22-28 mmol/L).

Reference: KDIGO 2024 – CKD Guideline (Practice Point 3.10.2)