The use of sodium bicarbonate in DKA is very controversial. Arguments Against HCO3 is produced endogenously with appropriate insulin therapy by oxidation of ketoacids. Alkalosis shifts the O2-dissociation curve to the left decreasing oxygen release to the tissues and potentially increasing lactic acidosis. Increases potassium needs by accelerating the entry of potassium intracellularly. May lead to worsening of cerebral acidosis.
Alkalosis decreases ionized Calcium.
Complications with pH at 7.0 or less Diminishes respiratory minute volume May produce hypotension with peripheral vasodilatation Impairs myocardial function and increases the risk of arrhythmias. Be especially concerned if hyponatremia was present at the start of treatment as the risk of cerebral edema may be increased further. Potassium Acidosis causes increase in serum potassium secondary to the intracellular to extracellular shifts. With the osmotic diuresis, potassium can be lost in great quantities. As the acidosis resolves, potassium shifts intracellularly, so potassium needs lessen.