EBQ:Sodium Bicarbonate use in DKA: Difference between revisions

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Review Article included patients with PH<7  
Review Article included patients with PH<7  
* '''Results:''' Sodium Bicarbonate didn't decrease time to improvement nor to hospital discharge<ref>[http://www.ncbi.nlm.nih.gov/pubmed/23737516 Ann Pharmacother. 2013 Jul-Aug;47(7-8):970-5]</ref>
* '''Results:''' Sodium Bicarbonate didn't decrease time to improvement nor to hospital discharge<ref>[http://www.ncbi.nlm.nih.gov/pubmed/23737516 Ann Pharmacother. 2013 Jul-Aug;47(7-8):970-5]</ref>
===Trial 4===
Retrospective Study of 39 patients with PH<7.1
* 24 patients received sodium bicarbonate
* 15 patients control
* '''Results:''' More Hypokalemia in the experiment group, No differences in clinical or biochemical parameters<ref>Crit Care Med. 1999 Dec;27(12):2690-3</ref>


==Sources==
==Sources==

Revision as of 13:25, 15 April 2014

Clinical Question

Should Sodium Bicarbonate be used to treat Diabetic Ketoacidosis ?

Background

Sodium bicarbonate is a solution which help alkalanizing the blood by binding the H+ and converting it to water and Co2. Many Physicians use it to treat DKA, but based on what ? Is there any evidence supporting its use ?

Pro Argument

Trial 1

Trial 2

Trial 3

Con Argument

Trial 1

21 patients underwent RCT

  • 10 patients (PH 6.9-7.14) received NaHco3
  • 11 patients in the control group

Results: No differences in Glucose level, bicarb level nor PH [1]

Trial 2

Prospective, Randomized, Blinded and cross over study included 14 patients

  • HCO3 level <17
  • Received Sodium Bicarbonate 2mmol/kg over 15 minutes

Results: Sodium Bicarbonate decreased Ionized Calcium, increased Paco2 and didn't improve hemodynamics[2]

Trial 3

Review Article included patients with PH<7

  • Results: Sodium Bicarbonate didn't decrease time to improvement nor to hospital discharge[3]

Trial 4

Retrospective Study of 39 patients with PH<7.1

  • 24 patients received sodium bicarbonate
  • 15 patients control
  • Results: More Hypokalemia in the experiment group, No differences in clinical or biochemical parameters[4]

Sources

  1. ↑ Ann Intern Med. 1986 Dec;105(6):836-40
  2. ↑ Ann Intern Med. 1990 Apr 1;112(7):492-8
  3. ↑ Ann Pharmacother. 2013 Jul-Aug;47(7-8):970-5
  4. ↑ Crit Care Med. 1999 Dec;27(12):2690-3

http://saudiemergencymedicine.com/should-you-use-sodium-bicarbonate-in-acidosis-stop-for-a-minute/

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