And, even though sodium bicarbonate can buffer metabolic acidosis, an event that increases muscle breakdown, no research has shown supplementation to improve muscle growth nor preserve muscle.
So in order to help compensate for an acidosis, hydrogen ions enter cells and potassium ions leave the cells and enter the blood, which might help with the acidosis, but results in hyperkalemia.
In the case of health, sodium bicarbonate indeed has a solid track record largely thanks to its metabolic acidosis buffering, aiding the kidneys in acid-base balance and preventing bone mineral loss.
Another situation is when living cells get affected by respiratory acidosis, which is when the carbon dioxide levels rise because a person isn’t breathing or ventilating it out of the lungs quickly enough.
Similarly, when there’s a metabolic acidosis from excess organic acids like lactic acid and ketoacids, protons can enter cells with the organic anion rather than having to get exchanged for potassium ions.
In HHS, you can sometimes see mild ketonemia and acidosis, but not to the extent that it’s seen in DKA, and in DKA you can see some hyperosmolarity, so there is definitely overlap between these two syndromes.
Treatment of a DKA episode involves giving plenty of fluids, which helps with dehydration, insulin which helps lower blood glucose levels, and replacement of electrolytes, like potassium; all of which help to reverse the acidosis.
Another cause of an internal potassium balance shift could be an acidosis, which is when the blood becomes too acidic, in other words, there’s a higher concentration of hydrogen ions —which means a lower blood pH.