There is no excuse for uncorrected acidosis, because the treatment is extremely simple and effective. Oral sodium bicarbonate tablets, taken daily, completely correct it. These are sold, without a prescription, as 10 grain tablets (1 grain = 65 mg). Sometimes they are called bicarb of soda. You probably have some in the kitchen cabinet in its powder form (Arm & Hammer Baking Soda®), but don't take it; it tastes pretty bad.

Why this archaic grain unit is still used for sodium bicarbonate is a mystery. The required dose, which your doctor will specify, varies from 3 to 8 tablets a day. There are no side effects and no toxicity, except that ingestion of the tablets causes belching or sometimes flatus. You can take the tablets all at once or spaced throughout the day.

Some nephrologists continue to ignore all but the most severe acidosis in patients with renal failure, maintaining that treatment is unnecessary. To my thinking, this view is indefensible. Why not treat an abnormality, if it can be done easily and cheaply, and might help?

Some physicians claim that they cannot give enough sodium bicarbonate to treat or prevent acidosis because of the resulting sodium retention. But increasing the dose of an effective diuretic, such as furosemide or furosemide plus metolazone, will get rid of any retained sodium.

Alkalosis, or high bicarbonate levels, is also seen in renal failure, reflecting a defect in acid-base regulation. As far as I know, it has no adverse consequences and no treatment is required.

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