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Oral Bicarbonate CKD Metabolic Acidosis — ESENeph MCQ

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HardAcid-BaseOral Bicarbonate CKD Metabolic AcidosisESENeph

A clinically euvolaemic adult with stable CKD G4 has bicarbonate 18 mmol/L on repeated venous samples, blood pressure 128/74 mmHg and no acute respiratory disorder. Which NICE NG203 criterion-based intervention is appropriate?

Educational content. Not a substitute for clinical judgement or local policy.

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Correct answer: B — Consider oral sodium bicarbonate because both NICE biochemical criteria are met

Explanation lettering: E = shown as A · A = shown as C · C = shown as E

B is correct. NICE advises considering oral sodium bicarbonate when both GFR is below 30 mL/min/1.73m² and serum bicarbonate is below 20 mmol/L. This stable patient meets both conditions but has no indication for emergency intravenous treatment or dialysis. Oral therapy still requires individualisation: sodium load, blood pressure, oedema, pill burden and serial bicarbonate are reviewed. Acetazolamide promotes bicarbonate loss, and additional animal protein increases dietary acid load. The recommendation is “consider”, not an instruction to treat an isolated mildly low value without confirmation and clinical context.

Reference: NICE NG203: chronic kidney disease assessment and management: https://www.nice.org.uk/guidance/ng203/chapter/Recommendations