No bicarb for met. acidosis?

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Specializes in LTC and School Health.

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.

Thanks.

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Never heard that, and it doesn't make sense to me. There are lots of reasons for not giving NaHCO3 in cases of metabolic acidosis, but that is not one I have ever heard of.

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Specializes in Emergency, Telemetry, Transplant.

I have never heard this rationale, but that does not mean that it does not exist. The most common reason that I have heard for not giving bicarb is that when you diminish the body's natural compensatory mechanisms for acidosis when you add bicarb to the mix. For example, I have never given bicarb even for a severe case of DKA.

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Specializes in Hem/Onc/BMT.

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.

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