Crisis and Sodium Bicarbonate

Insulinization with saline infusion for 2 hours is usually sufficient to halt ketosis and gluconeogenesis and begin reversing metabolic acidosis. Rarely, life-threatening acidosis exists with pH below 6.90. Blood pressure and cardiac output may be compromised. The anion gap may be approaching 40 mEq/dL, suggesting a coexisting component of lactic acidosis. These are the extreme conditions that justify consideration of sodium bicarbonate (NaHCO3) infusion. The concern involves the serum potassium, which could shift intracellularly with a rapid rise in pH. If present, hyperka-lemia would be an overall benefit, but if the ECG is indeterminate or hypokalemia already exists, a further decline in serum potassium would be disastrous. Thus, administration of sodium bicarbonate should be done slowly with caution. Bolus therapy with 100 mEq NaHCO3 can also cause a transient hyperosmolality. with a potentially deleterious water shift in the brain. Sodium bicarbonate is more safely delivered isotonically as 100 mEq or 100 mL added to 1 L of 0.45% NS. The addition of the sodium would make this almost an isotonic solution, and delivery of bicarbonate ions in the large volume would preclude any sudden pH shifts.

Curing Eczema Naturally

Curing Eczema Naturally

Do You Suffer From the Itching, Redness and Scaling of Chronic Eczema? If so you are not ALONE! It strikes men and women young and old! It is not just

Get My Free Ebook


Post a comment