Hello, dietitian here hoping to get some nephrology insight about starting sodium bicarbonate for patients. I work with the CKD population. I often see patients with a serum bicarbonate around 20, many times with borderline high or elevated potassium as well, who aren’t taking an alkali agent like sodium bicarbonate. A lot of these patients are very concerned about high potassium foods, of course, so I always try to consider other possible causes for hyperkalemia to avoid excessive dietary restriction. And in many case these patients would benefit from eating more fruits & veggies to help reduce their dietary acid load. My question is, at what point do you generally prescribe an alkali medication and what would be reasons for not prescribing it if someone’s bicarb is consistently around 20? Is it concern about the additional sodium? Does the medication just make the numbers look nicer w/o actually doing much to slow CKD progression? Thank you in advance for helping me understand this better!   submitted by   /u/DeciduousTree [link]   [comments]