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Sodium Bicarbonate & Renal Failure

By Shelly Morgan

A paper published in the December 1992 issue of the "American Journal of the Diseases of Diseases of Children" speculates that Tiny Tim in "A Christmas Carol" had a renal disease. The author further speculates that his miraculous recovery was brought about by treatment with sodium bicarbonate. While we'll never know what the author, Charles Dickens, intended in his writing of Tiny Tim's illness, this speculation underscores the importance of sodium bicarbonate in the treatment of kidney disease.

Definitions

Sodium bicarbonate, also called "bicarb," is the same thing as baking soda. When dissolved in water, the sodium atom dissociates from the bicarbonate moiety, producing a slightly basic solution. The high pH of this solution is why it is used to treat heartburn caused by acid stomach.

Renal failure is also known as kidney failure. In addition to describing the status of people whose kidneys are so diseased they can no longer sustain life, it also describes the status of people whose kidneys are significantly impaired, but who do not yet need dialysis or a transplant.

Acid-Base Balance

The pH of healthy people remains within a very narrow range. Both arterial blood and venous blood are slightly acidic, with arterial blood having a pH of 7.35 to 7.45 and venous blood having a pH between 7.32 and 7.42.

The pH of patients with kidney disease tends to become more acidic. Acidic blood is called acidemia. Conditions that cause acidemia are refered to as acidosis. The National Institute of Diabetes and Diabetes and Kidney Disease states that "chronic acidity of the blood leads to growth retardation, kidney stones, bone disease, chronic kidney disease, and possibly total kidney failure."

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Treatment

Nephrologists treat acidemia by prescribing sodium bicarbonate, which can be taken orally or added to the dialysis solutions. The National Kidney Foundation recommends monthly monitoring so that serum bicarbonate levels can be kept at 22 mmol/L. Maintaining a healthy the acid-base balance helps patients keep their weight up, which is important given that this population is vulnerable to muscle wasting. Keeping the serum bicarbonate level in a healthy range is also associated with fewer hospitalizations and shorter hospital stays.

Renal Tubular Acidosis

Renal tubular acidosis is caused by many disorders, including Addison's disease, sickle cell anemia, hyperparathyroidism, hyperthyroidism, Fanconi syndrome, hepatitis, AIDS, cirrhosis, analgesic nephropathy and many other conditions. Administration of sodium bicarbonate is an important part of treating these conditions because it prevents renal tubular acidosis from causing renal failure.

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