EBQ:Sodium Bicarbonate use in DKA

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 ?

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

Trial 2

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

• HCO³ level <17
• Received Sodium Bicarbonate 2mmol/kg over 15 minutes
• Results: Decreased Ionized Calcium, increased Paco₂ Sodium Bicarbonate didn't improve hemodynamics

Sources

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