We are aware of Rosival’s suggestions that infusion of sodium bicarbonate may be indicated in diabetic ketoacidosis. Established guidelines (referred to in our article) recommend sodium bicarbonate, but only in patients with a pH < 6.9, and this should be used with caution as paradoxical central nervous system acidosis may result, with adverse consequences (see also, Kitabchi AE, Umpierrez GE, Miles JM, Fisher JN. Hyperglycemic crises in adult patients with diabetes. Diabetes Care. 2009 Jul;32(7):1335–43; Savage MW, Dhatariya KK, Kilvert A, Rayman G, Rees JA, Courtney CH, Hilton L, Dyer PH, Hamersley MS. Joint British Diabetes Societies guideline for the management of diabetic ketoacidosis. Diabet Med. 2011 May;28(5):508–15).

The use of combined insulin and dextrose infusion is to suppress hepatic synthesis of ketone bodies. Measurement of serum insulin is not relevant in this situation.