Sodium Bicarbonate Treatment for Ketoacidosis

Ketoacidosis is an acidic condition of the arterial blood diagnosed. It's diagnosed through arterial blood sampling and a blood or urine analysis for ketones. Ketones can rapidly increase in diabetic's bloodstream, when glucose in the blood cannot be eliminated quickly enough by the kidneys because of insulin imbalance. Determining the underlying causes of the patient's acidosis is paramount before therapies are pursued. Sodium bicarbonate via an intravenous route is selectively chosen by a physician, primarily only in cases of renal failure and severe acidosis, according to the Journal of the American Society of Nephrologists.

Identification

• Sodium bicarbonate is a crystalline white solid that is most commonly found in a powdered or pressed tablet form. Sodium bicarbonate is an excellent alkaline source that can be used safely to neutralize a variety of acidic and basic chemical compounds. Metabolic acidosis describes a general condition of the body caused by too much acidity in bodily fluids. Ketoacidosis is a condition of too much acidity, which is almost always caused by diabetes mellitus. It is also often referred to as diabetic ketoacidosis or DKA. According to the JASN, sodium bicarbonate is more often used to treat ketonic acidosis than any other form of metabolic acidosis.

Mechanisms of Action

• Ketonic acidosis caused by insulin deficiency hampers the body's ability to transport glucose or "energy" to the cells. To compensate for the lack of glucose, the body draws glucose from fat cells, which result in a buildup of ketones. These ketones are relatively acidic to the blood as they enter into the bloodstream. The arterial blood pH drops as a result, creating potentially toxic conditions to vital body organs.

Significance

• Sodium bicarbonate is effective in lowering the pH balance of any acidic solution. Sodium bicarbonate when taken orally quickly mixes with the stomach's contents to reduce the overall pH or acidity. Sodium bicarbonate is used selectively in intravenously administered applications and is a temporary intervention. As in reducing stomach acidity when taken orally, sodium bicarbonate introduced through an intravenous route, acts to quickly reduce the acidity of the blood. Arterial blood is slightly alkaline; an ideal pH is 7.2 for most patients.

Considerations

• Typically for ketonic acidosis, intravenous administration of sodium bicarbonate is indicated rarely, and only when renal function is severely impaired, according to the JASN. Instead, regimens of fluids, insulin and electrolyte replacement are prescribed. It is the job of the kidneys to balance and regulate the electrolytes, bicarbonate and other blood chemistry. For diabetic ketoacidosis, the insulin deficiency is addressed, immediately followed by fluid replacement. Therapy with fluids generally restores the cells through hydration and allows renal flow to actually generate the body's own bicarbonate to regulate metabolic acidity. Blood and urine samples are used periodically to monitor the patient's condition and response to interventions.

Precautions & Warnings

• According to the National Institute of Health, warning signs of ketonic acidosis can include deep, rapid breathing, dry skin and mucous membranes, nausea, vomiting, stomach pain, fatigue and headaches. Ketone testing can be used in diabetic patients to screen for early ketoacidosis. Consult your physician for any health concerns or changes in your medical condition.