Acidosis in DKA is due to the overproduction of β-hydroxybutyric acid and acetoacetic acid. At physiological pH, these 2 ketoacids dissociate completely, and the excess hydrogen ions bind the bicarbonate, resulting in decreased serum bicarbonate levels.


What should your bicarbonate level be? Normal bicarbonate levels are: 23 to 30 mEq/L in adults.

why is there no Bicarb in DKA?

Most protocols require that the bicarbonate be >15 mEq/L before stopping the insulin drip. Therefore, persistent non-gap acidosis may delay transition off the insulin drip. Metabolic acidosis increases insulin resistance.

What IV solution is used for diabetic ketoacidosis? The initial priority in the treatment of diabetic ketoacidosis is the restoration of extra-cellular fluid volume through the intravenous administration of a normal saline (0.9 percent sodium chloride) solution.

why is potassium low in DKA?

Potassium levels can fluctuate severely during the treatment of DKA, because insulin decreases potassium levels in the blood by redistributing it into cells via increased sodium-potassium pump activity. A large part of the shifted extracellular potassium would have been lost in urine because of osmotic diuresis.

Why are chloride and bicarbonate decreased in diabetic ketoacidosis? Acidosis in DKA is due to the overproduction of β-hydroxybutyric acid and acetoacetic acid. In DKA, bicarbonate is replaced by β-hydroxybutyric acid and acetoacetic acid, so that the sum of bicarbonate and chloride concentrations is reduced and the anion gap is thus increased.

do you give Bicarb for DKA?

Consensus guidelines for the management of DKA recommended administering sodium bicarbonate to DKA patients who present with an initial blood gas pH of < 7.0. That recommendation was updated and changed in 2009 to limit sodium bicarbonate use to DKA patients with blood gas pH of < 6.9. More recently, Chua et al.

How do you make a bicarbonate of drip? 50 to 150 mEq sodium bicarbonate diluted in 1 L of D5W to be intravenously infused at a rate of 1 to 1.5 L/hour. Oral: 325 to 2000 mg orally 1 to 4 times a day.

Why does diabetic ketoacidosis cause metabolic acidosis?

Diabetic acidosis develops when acidic substances, known as ketone bodies, build up in the body. This most often occurs with uncontrolled type 1 diabetes. It is also called diabetic ketoacidosis and DKA. Hyperchloremic acidosis results from excessive loss of sodium bicarbonate from the body.

How do you calculate sodium bicarbonate deficit? Reference: Bicarbonate deficit: The amount of bicarbonate req'd to correct a metabolic acidosis can be estimated from the following formula: Volume of distribution (Vd) = Total body weight (kg) x [0.4 + (2.4/[HCO3-]) (Deficit) mEq of NaHCO3 = Vd x target change in [HCO3-]

What lab values indicate DKA?

While definitions vary, mild DKA can be categorized by a pH level of 7.25-7.3 and a serum bicarbonate level between 15-18 mEq/L; moderate DKA can be categorized by a pH between 7.0-7.24 and a serum bicarbonate level of 10 to less than 15 mEq/L; and severe DKA has a pH less than 7.0 and bicarbonate less than 10 mEq/L.

How quickly is blood glucose corrected in DKA?

The optimal rate of glucose decline is 100 mg/dL/h. Do not allow the blood glucose level to fall below 200 mg/dL during the first 4-5 hours of treatment. Hypoglycemia may develop rapidly with correction of ketoacidosis due to improved insulin sensitivity.

What is Kussmaul breathing?

Kussmaul breathing is a deep and labored breathing pattern often associated with severe metabolic acidosis, particularly diabetic ketoacidosis (DKA) but also kidney failure. It is this latter type of breathing pattern that is referred to as Kussmaul breathing.

Do you give potassium for DKA?

Serum potassium should be closely monitored during DKA treatment. Small amounts of potassium (20–30 mEq/L) are routinely added to intravenous fluids when serum potassium is between 3.3 and 5.3 mmol/L. No replacement is needed for potassium levels >5.3 mmol/L.

What are the diagnostic criteria for DKA?

In the past, the most widely used diagnostic criteria for DKA included a blood glucose level >250 mg/dl, a moderate degree of ketonemia, serum bicarbonate <15 mEq/l, arterial pH <7.3, and an increased anion gap metabolic acidosis.

Why does sodium bicarbonate cause cerebral edema?

Fatal cerebral oedema in adult diabetic ketoacidosis. Potential mechanisms include the administration of sodium bicarbonate leading to intracellular acidosis, excessive fluid infusion causing swelling of brain tissue, or reduction of plasma osmolarity by a rapid fall in glucose levels causing osmotic swelling.

Why is the anion gap high in DKA?

High anion gap The anion gap is affected by changes in unmeasured ions. In uncontrolled diabetes, there is an increase in ketoacids due to metabolism of ketones. Raised levels of acid bind to bicarbonate to form carbon dioxide through the Henderson-Hasselbalch equation resulting in metabolic acidosis.

What causes cerebral edema in DKA?

Cerebral edema is the leading cause of death in children presenting in diabetic ketoacidosis and occurs in 0.2 to 1% of cases. The osmolar gradient caused by the high blood glucose results in water shift from the intracelluar fluid (ICF) to the extracellular fluid (ECF) space and contraction of cell volume.

Why is blood pH level decreased in diabetes?

Diabetic ketoacidosis If you have diabetes, your blood may become acidic if your blood sugar levels aren't properly managed. Diabetic ketoacidosis happens when your body can't make enough insulin or use it properly. This gives off an acid waste called ketones. The acid builds up, triggering low blood pH.