Had a pt. with ph of 7.0 and HCO3 of 5.... and ketones +4. I asked the doc, why pt. isn't on bicarb and he mentioned something about organic ketones breaking down into sodium bicarb.
Has anyone ever heard of this?
I've been trying to google the this and have not found any thing related to this. I've also went into my nursing books and found nothing.
Jul 18, '12
by tokebi, MSN
here is a fairly recent systematic review on this topic.
bicarbonate in diabetic ketoacidosis - a systematic review
according to this, there were some cases that showed improvement with bicarb therapy but the benefit was only transient and did not extend beyond the initial 2 hours. speculation is "that bicarbonate therapy might interfere with tissue oxidation and with the clearance or renal excretion of ketones, hence accounting for the paradoxical worsening of ketosis." maybe this is what the doc was alluding to?
other reasons mentioned include: possibility that reversing acidosis rapidly with bicarb may screw up the hemoglobin-oxygen affinity and worsens tissue hypoxia. but this speculation needs more evidence.
for pediatric patients, a big concern seems to be increased risk of cerebral edema with bicarb therapy.
Last edit by tokebi on Jul 18, '12
: Reason: formatting