Table 3 Summary of studies on the use of sodium bicarbonate in DKA
From: Sodium bicarbonate and intubation in severe diabetic ketoacidosis: are we too quick to dismiss them?
Study | Year | Type of study | Study Population | Outcome | Confounders |
|---|---|---|---|---|---|
Treatment of severe diabetic ketoacidosis. A comparative study of two methods [9] | 1979 | Interventional study | 24 patients with severe diabetic ketoacidosis (pH < 7.10 | Fall of plasma glucose concentration, rise in arterial pH and decrease in 3-hydroxybutyrate were similar in both groups | • Difference in the insulin regime used in the two groups • Small sample size |
Sodium bicarbonate therapy in severe diabetic ketoacidosis [10] | 1983 | Retrospective analysis | 95 patients with severe DKA | Rates of recovery of plasma glucose, bicarbonate levels, pH, and level of consciousness were similar in both groups | • Variable pHs in patients • No consideration of alternate contributors to acidosis |
Metabolic effects of bicarbonate in the treatment of diabetic ketoacidosis [11] | 1984 | Randomized study (Bicarbonate vs normal saline) | 32 patients | Use of bicarbonate delayed the fall in blood lactate, lactate: pyruvate ratio and total ketone bodies | • Small sample size • Variable pHs in the patients • No assessment of the alternate contributors to acidosis |
Bicarbonate therapy in severe diabetic ketoacidosis [12] | 1986 | Randomized prospective protocol | 21 | No significant differences in the rate of decline of glucose or ketone levels or in the rate of increase in pH or bicarbonate levels in the blood or cerebrospinal fluid in either group | • Variable pHs in the patients • No assessment of the alternate contributors to acidosis • Variable dosing of bicarbonate |
Bicarbonate therapy in severe diabetic ketoacidosis. A double blind, randomized, placebo controlled trial [13] | 1991 | Double-blind, randomized, placebo controlled trial (Bicarbonate vs normal saline) | 9 | In patients with severe DKA (pH < 7.15), no clinical or metabolic differences in the 2 groups were seen | • Small sample size • No assessment of the alternate contributors to acidosis |
Counterproductive effects of sodium bicarbonate in diabetic ketoacidosis [14] | 1996 | Randomized study (Bicarbonate vs placebo) | 7 patients | Alkali administration augmented ketone production | • Small sample size • No assessment of alternate contributors to acidosis • Ambiguous dosing of bicarbonate |
Does bicarbonate therapy improve the management of severe diabetic ketoacidosis? [15] | 1999 | Randomized study (Bicarbonate vs placebo) | 39 | In patients with severe DKA, with pH between 6.90 -7.1, there was no difference in normalization of clinical or biochemical parameters | • Small sample size • No assessment of the alternate contributors to acidosis |
Diabetic ketoacidosis and bicarbonate therapy [16] | 2000 | Retrospective study | 39 patients with severe DKA | Bicarbonate in patients with severe DKA does not produce a more rapid normalisation of biochemical or clinical parameters | • Retrospective nature of the study • No assessment of the alternate contributors to acidosis • Variable dosing of bicarbonate |
Intravenous sodium bicarbonate therapy in severely acidotic diabetic ketoacidosis [17] | 2007–2011 | Retrospective cohort study | 86 | Intravenous bicarbonate therapy did not decrease time to resolution of acidosis or time to hospital discharge for patients with DKA with initial pH < 7 | • No data on ketone or lactate levels • Use and dosing of bicarbonate was dictated by physician preference |
Bicarbonate in diabetic ketoacidosis – a systematic review [18] | 2011 | Systematic Review of 44 articles, including 3 randomized controlled trials | No benefit of sodium bicarbonate in the emergency treatment of DKA | No inclusion of patients with a pH of < 6.85 | |
Sodium bicarbonate is safe but not useful in the management of severe diabetic ketoacidosis [19] | 2018–2022 | Retrospective study | 232 patients aged 1 month-18 years with pH < 6.9 | • Length of stay in the PICU, insulin infusion duration, and acidosis recovery time were significantly higher in the bicarbonate group • Sodium bicarbonate had no significant effect on respiratory and heart rates, pH, PaCO2, anion gap, and bicarbonate level • Improvement of GCS was greater in the bicarbonate group | • No assessment of the alternate contributors to acidosis • Variable dosing of bicarbonate |