Diabetics who poorly manage their disease might develop a life-threatening condition called diabetic ketoacidosis, which is characterized by nausea or vomiting, dry mouth, fruity breath, deep rapid breathing and abdominal pain. Diabetic ketoacidosis occurs when fat and protein is used as the body’s main energy source. As a result, ketones, which are poisonous in large quantities, accumulate and acidify body fluids, which can be neutralized by sodium bicarbonate therapy. Sodium bicarbonate is available in various forms, such as solutions, powders, tablets, capsules and granules.
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Diabetes affected 25.6 million Americans 20 years of age and older in 2010, accordng to the National Diabetes Information Clearinghouse. There are two main types of diabetics: insulin resistant, or type 2 diabetics; and insulin dependent, or type 1 diabetics. Insulin-resistant diabetics produce insulin but do not respond to it. Insulin-dependent diabetics do not produce insulin and must self-administer the hormone via an insulin pump or daily injections. Diabetes, which was previously regarded as an adulthood disease, has been increasingly diagnosed in children and adolescents. According to the Centers for Disease Control and Prevention, most children diagnosed with type 2 diabetes are 10 to 19 years of age, obese, have a family history of type 2 diabetes and exhibit insulin resistance.
Diabetic Ketoacidosis Onset
Diabetics are prone to ketoacidosis because of carbohydrate restrictions and the body’s inability to metabolize glucose. Carbohydrates, which the body converts to glucose, serve as the body’s main energy source; however, in its absence, the body initiates lipolysis and proteolysis, or fat and protein metabolism. As a result of these two mechanisms, the liver releases ketones that accumulate in body fluids, which increases body fluid acidity. As ketones accumulate, body fluid pH declines. A pH level below 7.0 indicates ketoacidosis onset and warrants sodium bicarbonate therapy or other treatments. Because sodium bicarbonate is alkaline, or basic, it neutralizes blood and urine acidity, returning extracellular pH levels to 7.4.
Sodium Bicarbonate Therapy
Diabetics over age 6 experiencing ketoacidosis can consume sodium bicarbonate to neutralize body fluid acidity if taken in correct dosages prescribed by a doctor. A body fluid pH level greater than 7.0 reactivates insulin, resumes glucose metabolism and halts lipolysis and proteolysis, which eliminates the need for sodium bicarbonate. Although sodium bicarbonate treatments reduce extracellular acidity, it can increase intracellular acidity. Sodium bicarbonate treatments reduce serum potassium levels, which can reduce cardiac contractility and illicit irregular cardiac electrical activity. Sodium bicarbonate therapy may delay the removal of ketones from the blood and, unless kidney function is compromised, is not necessary to treat ketoacidosis.
A study published in January 2004 by “Diabetes Care” reported that sodium bicarbonate therapy remains controversial because randomized research studies have not shown either a decrease or increase in mortality or morbidity with bicarbonate therapy in ketoacidosis patients. However, the “Journal of the American Society of Nephrology” published a study in 2009 that reported that sodium bicarbonate acidosis treatments have been linked to mortality. These deaths occurred as a result of declining blood pressure and a decreased cardiac output.
REFERENCES & RESOURCES
- "Journal of the American Society of Nephrology"; Bicarbonate Therapy in Severe Metabolic Acidosis; Sandra Sabatini et al.; March 2008
- "Diabetes Care"; Hyperglycemic Crises in Diabetes; Abbas E. Kitabchi et al.; January 2004
- "American Family Physician"; Management of Diabetic Ketoacidosis; Abbas E. Kitabchi et al.; August 1999
- MayoClinic.com; Sodium Bicarbonate (Oral Route, Intravenous Route, Subcutaneous Route); May 2011
- MedlinePlus; Diabetic Ketoacidosis; Ari S. Eckman; April 2010
- Diabetes Information Library; Diabetoc Ketoacidosis; Terri Kordella; March 2005
- MedlinePlus; Metabolic Acidosis; David C. Dugdale, III; November 2009
- PubMed Health; Diabetic Ketoacidosis; June 2011