 The sodium bicarbonate level is influenced by the flow-rate of the replacement fluid citrate intake and the dialysate flow bicarbonate intake. It is monitored every 6 hours and is corrected during treatment by altering the dialysate flow. Reducing the flow rate lowers bicarbonate intake in case of metabolic alkalosis, raising flow increases the bicarbonate intake in case of metabolic acidosis. If these adjustments are not successful, further corrections can be done by adding bicarbonate into the next dialysate fluid bag, when it is changed: 