Use of sodium bicarbonate and blood gas monitoring in diabetic ketoacidosis: A review

Abstract

Diabetic ketoacidosis (DKA) is a severe and too-common complication of uncontrolled diabetes mellitus. Acidosis is one of the fundamental disruptions stemming from the disease process, the complications of which are potentially lethal. Hydration and insulin administration have been the cornerstones of DKA therapy; however, adjunctive treatments such as the use of sodium bicarbonate and protocols that include serial monitoring with blood gas analysis have been much more controversial. There is substantial literature available regarding the use of exogenous sodium bicarbonate in mild to moderately severe acidosis; the bulk of the data argue against significant benefit in important clinical outcomes and suggest possible adverse effects with the use of bicarbonate. However, there is scant data to support or refute the role of bicarbonate therapy in very severe acidosis. Arterial blood gas (ABG) assessment is an element of some treatment protocols, including society guidelines, for DKA. We review the evidence supporting these recommendations. In addition, we review the data supporting some less cumbersome tests, including venous blood gas assessment and routine chemistries. It remains unclear that measurement of blood gas pH, via arterial or venous sampling, impacts management of the patient substantially enough to warrant the testing, especially if sodium bicarbonate administration is not being considered. There are special circumstances when serial ABG monitoring and/or sodium bicarbonate infusion are necessary, which we also review. Additional studies are needed to determine the utility of these interventions in patients with severe DKA and pH less than 7.0.

Cetoacidosis por estrés: caso clínico en paciente con atrofia muscular espinal

“…La insulina podría precipitar hipoglicemias con riesgo vital. El bicarbonato de sodio intravenoso es controversial en pacientes con cetoacidosis 21 , pero cuando el cuadro es grave, puede ser necesario para evitar las importantes consecuencias cardiovasculares de la acidemia 22 . La infusión inicial de bicarbonato no tuvo ningún efecto en nuestra paciente, sí, en cambio, la infusión de glucosa y aminoácidos (Figura 2).…”

Profile of Diabetic Ketoacidosis Patients at Regional Public Hospital Dr. Soetomo in 2017

“…Following this process, the patient would have lower pH, lower bicarbonate levels, and higher anion gaps in blood gas analysis results. Moreover, the PCO2 may help with assessing the respiratory compensation for metabolic acidosis and deciding when to use a mechanic ventilator (Patel, Ahmed, Gunapalan, & Hesselbacher, 2018).…”

Bicarbonate Therapy for Critically Ill Patients with Metabolic Acidosis: A Systematic Review

“…However, arterial blood gas is the gold standard tool for diagnosis, the results of which guide the treatment [24]. Metabolic acidosis affects the cardiovascular, respiratory, metabolic, cerebral, renal, haematological, endocrine, musculoskeletal, and immunological systems [25][26][27][28][29].…”