Intravenous Sodium Bicarbonate Therapy in Severely Acidotic Diabetic Ketoacidosis

Duhon, Bryson M.; Attridge, Rebecca L.; Franco-Martinez, A. Crystal; Maxwell, Pamela R.; Hughes, Daniel C.

doi:10.1345/aph.1s014

Cited by 51 publications

(30 citation statements)

References 16 publications

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“…If subcutaneous administration is used, it is important to provide adequate fluid replacement, nurse training, frequent bedside testing, infection treatment if warranted, and appropriate follow-up to avoid recurrent DKA. Several studies have shown that the use of bicarbonate in patients with DKA made no difference in resolution of acidosis or time to discharge, and its use is generally not recommended (80). For further information regarding treatment, refer to recent in-depth reviews (3).…”

Section: Diabetic Ketoacidosis and Hyperosmolar Hyperglycemic Statementioning

confidence: 99%

15. Diabetes Care in the Hospital: Standards of Medical Care in Diabetes—2019

2018

Diabetes Care

182

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The American Diabetes Association (ADA) "Standards of Medical Care in Diabetes" includes ADA's current clinical practice recommendations and is intended to provide the components of diabetes care, general treatment goals and guidelines, and tools to evaluate quality of care. Members of the ADA Professional Practice Committee, a multidisciplinary expert committee, are responsible for updating the Standards of Care annually, or more frequently as warranted. For a detailed description of ADA standards, statements, and reports, as well as the evidence-grading system for ADA's clinical practice recommendations, please refer to the Standards of Care Introduction. Readers who wish to comment on the Standards of Care are invited to do so at professional.diabetes.org/SOC. In the hospital, both hyperglycemia and hypoglycemia are associated with adverse outcomes, including death (1,2). Therefore, inpatient goals should include the prevention of both hyperglycemia and hypoglycemia. Hospitals should promote the shortest safe hospital stay and provide an effective transition out of the hospital that prevents acute complications and readmission. For in-depth review of inpatient hospital practice, consult recent reviews that focus on hospital care for diabetes (3,4). HOSPITAL CARE DELIVERY STANDARDS Recommendation 15.1 Perform an A1C on all patients with diabetes or hyperglycemia (blood glucose .140 mg/dL [7.8 mmol/L]) admitted to the hospital if not performed in the prior 3 months. B High-quality hospital care for diabetes requires both hospital care delivery standards, often assured by structured order sets, and quality assurance standards for process improvement. "Best practice" protocols, reviews, and guidelines (2) are inconsistently implemented within hospitals. To correct this, hospitals have established protocols for structured patient care and structured order sets, which include computerized physician order entry (CPOE). Considerations on Admission Initial orders should state the type of diabetes (i.e., type 1 or type 2 diabetes) or no previous history of diabetes. Because inpatient insulin use (5) and discharge orders (6) can be more effective if based on an A1C level on admission (7), perform an A1C test on all patients with diabetes or hyperglycemia admitted to the hospital if the test has not been performed in the prior 3 months (8). In addition, diabetes self-management knowledge and behaviors should be assessed on admission and

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Section: Diabetic Ketoacidosis and Hyperosmolar Hyperglycemic Statementioning

confidence: 99%

15. Diabetes Care in the Hospital: Standards of Medical Care in Diabetes—2019

2018

Diabetes Care

182

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“…The causes can be many and varied, with each requiring specific treatments. Otherwise, acidosis itself may require symptomatic treatment in severe cases [3][4][5].…”

Section: Introductionmentioning

confidence: 99%

Prognosis of patients presenting extreme acidosis (pH <7) on admission to intensive care unit

Allyn

Vandroux

Jabot

et al. 2016

Journal of Critical Care

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“…The study concluded that the times to resolution of acidosis were similar in the two groups (8 hrs vs. 8 hrs, p=0.72). Additionally, patients who received IV bicarbonate also received slightly more insulin in the first 12 hrs of hospital stay (48 U vs. 44 U, p= 0.05) and first 24 hrs (100 U vs. 86 U p=0.04) 18. A prospective randomized study of 21 patients failed to show beneficial or adverse effects on morbidity and mortality with bicarbonate therapy in patients with DKA whose admission arterial pH was between 6.9-7.1.…”

Section: Bicarbonatementioning

confidence: 96%

Diabetic ketoacidosis: Should current management include subcutaneous insulin injections?

Edriss

2017

SW Resp Crit Care Chron

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Intravenous Sodium Bicarbonate Therapy in Severely Acidotic Diabetic Ketoacidosis

Abstract: Intravenous bicarbonate therapy did not decrease time to resolution of acidosis or time to hospital discharge for patients with DKA with an initial pH less than 7.0.

Cited by 51 publications

References 16 publications

15. Diabetes Care in the Hospital: Standards of Medical Care in Diabetes—2019

15. Diabetes Care in the Hospital: Standards of Medical Care in Diabetes—2019

Prognosis of patients presenting extreme acidosis (pH <7) on admission to intensive care unit

Diabetic ketoacidosis: Should current management include subcutaneous insulin injections?

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