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