ACLS REVISION: The only time Sodium Bicarbonate should be used in Resuscitation (and not for the acidosis)
There is sinus rhythm with a prolonged QRS, right precordial ST elevation, and very peaked T-waves in V4-V6. This is HYPERKALAEMIA until proven otherwise.
Sodium bicarbonate therapy in DKA (or any other acidosis for that matter) is associated with risks that outweigh NO BENEFITS…DO NO HARM!!! Neither a recent systematic review nor the largest single retrospective cohort of severe DKA support routine use of bicarbonate therapy in DKA Bicarbonate is associated with risk of cerebral oedema and prolonged hospitalisation […]
DID YOU KNOW: “Evidence that significant harmful effects are derived from metabolic acidosis by itself has NOT been provided in human beings” Sodium Bicarbonate does NOT treat metabolic acidosis (it just gives you numbers that make you happy about yourself while the patient dies) – Death by Sodium Bicarbonate
Sodium bicarbonate may increase serum pH, but may worsen rather than improve prognosis. Other than indications where sodium bicarbonate is the treatment for the acidosis (such as TCA overdose), the treatment for metabolic acidosis is to correct the underlying cause, whatever it may be.
Insulin Bolus: http://rebelem.com/benefit-initial-insulin-bolus-diabetic-ketoacidosis/ Bicarb: http://rebelem.com/benefit-sodium-bicarbonate-dka/