Clinical Information Discusses physiology, pathophysiology, and general clinical aspects, as they relate to a laboratory test
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 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 acid-base imbalance in the respiratory and metabolic systems. Some of these conditions are diarrhea, renal tubular acidosis, carbonic anhydrase inhibitors, hyperkalemic acidosis, renal failure, and ketoacidosis.
Alterations of bicarbonate and CO2 dissolved in plasma are characteristic of acid-base imbalance. The nature of the imbalance cannot, however, be inferred from the bicarbonate value itself, and the determination of bicarbonate is rarely ordered alone. Its value has significance in the context of other electrolytes determined with it and in screening for electrolyte imbalance.
Cautions Discusses conditions that may cause diagnostic confusion, including improper specimen collection and handling, inappropriate test selection, and interfering substances
Because the determination of bicarbonate actually includes dissolved CO2, this fraction will escape from the specimen into the air once the stopper is removed from the vacutainer tube. The rate of change in the bicarbonate determination is approximately 6mmo1/L in the course of 1 hour. If the logistics in the lab are different for processing high volume routine specimens from STAT specimens, the extent of the error is bicarbonate determinations will be different. This is due to the length of time between removal of the stopper and sampling of the specimen for analysis. Fortunately the errors in either case are relatively small and of little concern clinically.
Reference Values Describes reference intervals and additional information for interpretation of test results. May include intervals based on age and sex when appropriate. Intervals are Mayo-derived, unless otherwise designated. If an interpretive report is provided, the reference value field will state this.
12-24 months: 17-25 mmol/L
3 years: 18-26 mmol/L
4-5 years: 19-27 mmol/L
6-7 years: 20-28 mmol/L
8-17 years: 21-29 mmol/L
> or =18 years: 22-29 mmol/L
1-3 years: 18-25 mmol/L
4-5 years: 19-26 mmol/L
6-7 years: 20-27 mmol/L
8-9 years: 21-28 mmol/L
> or =10 years: 22-29 mmol/L
Reference values have not been established for patients that are <12 months of age.
Clinical References Provides recommendations for further in-depth reading of a clinical nature
Tietz Textbook of Clinical Chemistry, Edited by Burtis and Ashwood. Philadelphia, PA, WB Saunders Company, 1994.