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When you breathe, you bring oxygen (O2) into your lungs and release carbon dioxide (CO2). Carbon dioxide in your blood is present in three forms: carbonic acid (H2CO3), CO2 dissolved in the blood, and bicarbonate (HCO3-), the predominant form. Bicarbonate is a negatively charged ion that is excreted and reabsorbed by your kidneys. Its function is to help maintain the acid-base balance (pH) and to work with sodium, potassium, and chloride to maintain electrical neutrality at the cellular level. Measuring bicarbonate gives an estimation of acid-base balance. This is usually sufficient, but measurements of gasses dissolved in the blood may be done if more information is needed. Bicarbonate may be measured with sodium, potassium, and chloride in an electrolyte profile as it is the balance of these that gives your doctor the most information.


Bicarbonate is the second largest fraction of the anions in plasma. Included in this fraction are the bicarbonate (HCO3[-]) and carbonate (CO3[-2]) ions, carbon dioxide in physical solution, as well as the carbamino compounds. At the physiological pH of blood, the concentration of carbonate is 1/1000 that of bicarbonate. The carbamino compounds are also present in such low quantities that they are generally not mentioned specifically.

The bicarbonate content of serum or plasma is a significant indicator of electrolyte dispersion and anion deficit. Together with pH determination, bicarbonate measurements are used in the diagnosis and treatment of numerous potentially serious disorders associated with an acid-base imbalance in the respiratory and metabolic systems. Some of these conditions are diarrhoea, renal tubular acidosis, carbonic anhydrase inhibitors, hyperkalemic acidosis, renal failure, and ketoacidosis.


No test preparation is needed.


Bicarbonate testing may be requested, usually as part of an electrolyte profile when:
  • you are having a routine blood test;
  • your doctor suspects that water imbalance is upsetting your electrolyte balance;
  • to help evaluate your acid-base balance (pH);
  • to monitor a condition or treatment that might cause an electrolyte imbalance.


When bicarbonate levels are higher or lower than normal, it suggests that your body is having trouble maintaining its acid-base balance either by failing to remove carbon dioxide or perhaps because of an electrolyte imbalance, particularly a deficiency of potassium. Both of these imbalances may be due to a wide range of dysfunctions.

Some of the causes of a low bicarbonate level include:

  • A hormone disorder such as Addison's disease
  • Chronic diarrhoea
  • Diabetic ketoacidosis
  • Metabolic acidosis
  • Kidney disease
  • Alcohol poisoning
  • Salicylate (aspirin) overdose
Increased levels may be due to:
  • Severe vomiting
  • Lung diseases, including chronic obstructive pulmonary disease (COPD)
  • Hormone disorders such as Cushing's or Conn's syndrome
  • Metabolic alkalosis


The laboratory test results are NOT to be interpreted as results of a "stand-alone" test. The test results have to be interpreted after correlating with suitable clinical findings and additional supplemental tests/information. Your healthcare providers will explain the meaning of your tests results, based on the overall clinical scenario. Certain medications that you may be currently taking may influence the outcome of the test. Hence, it is important to inform your healthcare provider of the complete list of medications (including any herbal supplements) you are currently taking. This will help the healthcare provider interpret your test results more accurately and avoid unnecessary chances of a misdiagnosis.

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