Use of sodium bicarbonate and blood gas monitoring in diabetic ketoacidosis: A review

Table 1 Clinical effects of metabolic acidosis[27,28]

System	Clinical effects
Cardiovascular	Depressed myocardium contractility
	Changes in SVR
	Acidosis-aided catecholamine release opposes acidosis-mediated vasodilation.
	Net SVR depends on the sum of both effects
	Conduction defects and dysrhythmias
	Impaired response to exogenous vasopressors
Pulmonary	Increased work of breathing and respiratory failure
	Compensatory alveolar hyperventilation
	Dyspnea (Kussmaul’s breathing)
	Acute decrease in hemoglobin oxygen affinity (Bohr Effect)
	Temporary: Affinity rises after 36 h due to depletion of RBC 2,3-DPG
Renal	Pseudo-hyperkalemia
	Hyperuricemia
	Hypercalcemia
Hematological effect	Impaired coagulation
	Thrombocytopenia
	Reduced fibrinogen and thrombin formation
	Impaired clotting factor function
	Factor Va
	Factor VIIa
	Factor VIIa/tissue factor complex
Endocrine	Insulin resistance
	Catecholamine, cortisol, PTH and aldosterone stimulation
	Bone demineralization
	Protein wasting
	Free radical formation
Musculoskeletal system	Anti-anabolic effect on the bone growth centers in chronic metabolic acidosis
	Muscle fatigue
Central nerve system	Cerebral edema
	Depressed sensorium
Immune system	Impaired leukocyte function
	Increased susceptibility to infections

SVR: Systemic vascular resistance; RBC: Red blood cell; 2,3-DPG: 2,3 diphosphoglycerate; PTH: Parathyroid hormone.