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 ?

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]

Trial 5

Retrospective of 147 pediatric DKA cases with PH<7.15

90 patients received bicarbonate
57 patients contol

Results:Bicarbonate didn't improve clinical outcomes, but hospitalization was prolonged with the bicarb group [5]

Sources

↑ Ann Intern Med. 1986 Dec;105(6):836-40
↑ Ann Intern Med. 1990 Apr 1;112(7):492-8
↑ Ann Pharmacother. 2013 Jul-Aug;47(7-8):970-5
↑ Crit Care Med. 1999 Dec;27(12):2690-3
↑ Ann Emerg Med. 1998 Jan;31(1):41-8

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

Authors:

[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

[5] Ann Emerg Med. 1998 Jan;31(1):41-8

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