EBQ:Sodium Bicarbonate use in DKA

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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

Looking for any studies 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 [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]

Trial 6

Systematic Review of 44 studies Results: Bicarbonate use increased cerebral edema and prolonged hospitalization in pediatrics age group and increased ketosis and need for potassium supplementation[6]

Sources

  1. ↑ Morris LR, Murphy MB, Kitabchi AE. Bicarbonate therapy in severe diabetic ketoacidosis. Ann Intern Med. 1986 Dec;105(6):836-40. PubMed PMID: 3096181
  2. ↑ Cooper DJ, Walley KR, Wiggs BR, Russell JA. Bicarbonate does not improve hemodynamics in critically ill patients who have lactic acidosis. A prospective, controlled clinical study. Ann Intern Med. 1990 Apr 1;112(7):492-8. PubMed PMID: 2156475
  3. ↑ Duhon B, Attridge RL, Franco-Martinez AC, Maxwell PR, Hughes DW. Intravenous sodium bicarbonate therapy in severely acidotic diabetic ketoacidosis. Ann Pharmacother. 2013 Jul-Aug;47(7-8):970-5. doi: 10.1345/aph.1S014. Epub 2013 Jun 4. PubMed PMID: 23737516.
  4. ↑ Viallon A, Zeni F, Lafond P, Venet C, Tardy B, Page Y, Bertrand JC. Does bicarbonate therapy improve the management of severe diabetic ketoacidosis? Crit Care Med. 1999 Dec;27(12):2690-3. Review. PubMed PMID: 10628611.
  5. ↑ Ann Emerg Med. 1998 Jan;31(1):41-8
  6. ↑ Ann Intensive Care. 2011; 1: 23

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