The management of acid-base balance in children with diabetic acidosis

Kuzemko, J A; Fielding, D W; Hudson, F. P.

doi:10.1136/pgmj.45.519.21

Cited by 8 publications

(4 citation statements)

References 11 publications

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“…Concentrated bicarbonate dosing based on calculations using predictive formulas incorporating base deficit [37,38] results in a tendency for over-correction and alkalosis [29,30]. Aiming for a more modest and intermediate pH target with bicarbonate dose less than half of that predicted, or dose titrated based on pH severity, were some of the variable approaches adopted subsequently by investigators [4,23].…”

Section: Resultsmentioning

confidence: 99%

“…On the other hand, there is no evidence that the rapid reversal of acidemia with bicarbonate therapy improves any clinical outcome, especially in the pediatric cohort. Documentation of improved mental status from initial diabetic coma following treatment (including bicarbonate therapy) came only from pediatric and adult case reports and series [23,29,30,36]. It could not be ascertained, however, if a favorable neurological outcome was attributable to the use of initial bicarbonate therapy.…”

Section: Discussionmentioning

confidence: 99%

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Bicarbonate in diabetic ketoacidosis - a systematic review

Chua

Schneider

Bellomo

2011

Ann. Intensive Care

115

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ObjectiveThis study was designed to examine the efficacy and risk of bicarbonate administration in the emergent treatment of severe acidemia in diabetic ketoacidosis (DKA).MethodsPUBMED database was used to identify potentially relevant articles in the pediatric and adult DKA populations. DKA intervention studies on bicarbonate administration versus no bicarbonate in the emergent therapy, acid-base studies, studies on risk association with cerebral edema, and related case reports, were selected for review. Two reviewers independently conducted data extraction and assessed the citation relevance for inclusion.ResultsFrom 508 potentially relevant articles, 44 were included in the systematic review, including three adult randomized controlled trials (RCT) on bicarbonate administration versus no bicarbonate in DKA. We observed a marked heterogeneity in pH threshold, concentration, amount, and timing for bicarbonate administration in various studies. Two RCTs demonstrated transient improvement in metabolic acidosis with bicarbonate treatment within the initial 2 hours. There was no evidence of improved glycemic control or clinical efficacy. There was retrospective evidence of increased risk for cerebral edema and prolonged hospitalization in children who received bicarbonate, and weak evidence of transient paradoxical worsening of ketosis, and increased need for potassium supplementation. No studies involved patients with an initial pH < 6.85.ConclusionsThe evidence to date does not justify the administration of bicarbonate for the emergent treatment of DKA, especially in the pediatric population, in view of possible clinical harm and lack of sustained benefits.

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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Bicarbonate in diabetic ketoacidosis - a systematic review

Chua

Schneider

Bellomo

2011

Ann. Intensive Care

115

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show abstract

“…The use of intravenous alkali therapy in the management of diabetic ketoacidosis has many advocates (Kuzemko, Fielding, and Hudson, 1969) but it is not deemed necessary by many units, includinc the Joslin Clinic, Boston, Mass. (Young and Bradley, 1967).…”

Section: Discussionmentioning

confidence: 99%

Mortality in juvenile diabetes mellitus over 25 years.

Smith¹,

Hudson²

1976

Archives of Disease in Childhood

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“…This requires the use of the Astrup apparatus for estimating pH, Pco2 and standard bicarbonate, and should be regarded as a bed-side rather than a laboratory procedure. The correction of metabolic acidosis in such a way is efficient, rapid and safe (Kuzemko, Fielding & Hudson, 1969).…”

Section: Fluid and Electrolytesmentioning

confidence: 99%