DKA AND HHS

A special case of potassium loss occurs with diabetic ketoacidosis. In addition to urinary losses from polyuria and volume contraction, there is also obligate loss of potassium from kidney tubules as a cationic partner to the negatively charged ketone, β-hydroxybutyrate.

so yes, i found that acidosis causes extracellular shift of potassium… but in DKA, the total potassium is low, but there is HYPERKALEMIA. so when treating.. its essential to measure serum potassium!! treatment may exarcerbate the danger of this situation!!!!

ok and you know insulin causes intracellular shift of potassium.

ok yes , this is acidosis so it would be wise to give bicarbonates to ‘tame’ this acidosis?????
NO.

from what i conceive after doing some reading, the use of bicarbonates is debatable. and not recommendable, UNLESS PH IS LESS THAN 7.

ok yes, bicarbonates are one of the lines of treatment in hyperkalemia and in DKA, HYPERKALEMIA CAN HAPPEN BUT REMEMBER THE TOTAL POTASSIUM IN THE BODY IS LOW.

somehow,it was stated that the bicarbonates causes a PARADOXICAL ACIDOSIS PF THE NERVOUS SYSTEM. WHY?

Concerns were raised 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.

Bicarbonate therapy in patients with DKA appeared to be associated with increased obtundation and profound cerebrospinal fluid (CSF) acidosis in an early study [47]. A possible explanation for this observation may be the preferential movement across the blood-brain barrier of CO2 compared with bicarbonate during treatment of DKA, when both PCO2 and bicarbonate levels rise in the blood. It was postulated that rapid reversal of acidemia with bicarbonate might promote paradoxical CSF acidosis and contribute to adverse neurological outcomes.

the use of bicarbonates in DKA is indeed a complex subject by itself. so you can read further here about a study of bicarbs and dka.

personally ,to be safe, lets just stick to whats written in the books.

bicarbs and dka

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