Acid-Base Changes During Treatment of Diabetic Ketoacidosis

Fatal Diabetic Ketoacidosis: Major Causes and Approaches to Their Prevention

“…97 It is interesting that mortality figures as low as 1.5 per cent were observed in the prebicarbonate era, 98 and that more recent studies have suggested that bicarbonate administration does not have any effect upon the recovery from diabetic ketoacidosis. 99 ' 100 Therefore, one could seriously question whether bicarbonate should be used at all in the treatment of diabetic ketoacidosis. 101 If it does little good and may precipitate shock and tissue hypoxia, we would suggest that the use of this compound in the treatment of diabetic ketoacidosis should be as limited as possible.…”

The oxygen transport system of red blood cells during diabetic ketoacidosis and recovery

“…It has been widely accepted that diabetic ketoacidosis is not likely to impair the oxygen delivery capacity of red blood cells, because a decrease in haemoglobin oxygen affinity by acidosis, i.e. the Bohr effect, will oppose the adverse shift of the oxygen haemoglobin equilibrium induced by the effect of acidosis on red cell 2,3-diphosphoglycerate (2,3-DPG) [1,2,3,4,5]. Recently, however, the implications of 2,3-DPG on the Bohr effect itself using in vitro techniques have emerged [6,7,8,9,10], the Bohr effect being lower with decreasing erythrocyte 2,3-DPG.…”

Severe Diabetic Metabolic Decompensation

“…By correcting the extracellular acidosis without influencing the causal inadequate cellular utilization of glucose, the use of alkali will increase the liability towards hypokalemia and may produce a dangerous disequilibrium between the intracellular and extracellular pH (Posner and Plum 1967). Its use should be avoided unless serial pH estimations show no improvement with conventional therapy (King et al , 1974) or if an additional situation exists which itself requires the prompt correction of metabolic acidosis (Assal et al , 1974).…”