EBQ:Sodium Bicarbonate use in DKA - Revision history

Danbot: Added standard JC sections to evidence review

2026-03-21T22:48:54Z

Added standard JC sections to evidence review

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 ==Clinical Question==
 What is the utility of sodium bicarbonate in the treatment of [[Diabetic Ketoacidosis]]?
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 ===Trial 8===
 RCT of 7 Patients 3 of them received NaHco3 and showed delay ketones clearance for 6 hours compard with control<ref>Okuda Y, Adrogue HJ, Field JB, Nohara H, Yamashita K. Counterproductive effects of sodium bicarbonate in diabetic ketoacidosis. J Clin Endocrinol Metab. 1996 Jan;81(1):314-20. PubMed PMID: 8550770.</ref>
 ==Sources==

Ostermayer: /* Sources */

2015-11-02T19:25:40Z

Sources

← Older revision		Revision as of 19:25, 2 November 2015
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	==Sources==		==Sources==
	~~<references/>~~		{{Reflist\|2}}
	[[Category:EBQ]]		[[Category:EBQ]]

	==Helpful Links==		==Helpful Links==
	http://saudiemergencymedicine.com/should-you-use-sodium-bicarbonate-in-acidosis-stop-for-a-minute/		http://saudiemergencymedicine.com/should-you-use-sodium-bicarbonate-in-acidosis-stop-for-a-minute/

Rossdonaldson1 at 04:25, 10 December 2014

2014-12-10T04:25:07Z

← Older revision		Revision as of 04:25, 10 December 2014
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	==Clinical Question==		==Clinical Question==
	What is the utility of sodium bicarbonate in the treatment of [[Diabetic Ketoacidosis]]?		What is the utility of sodium bicarbonate in the treatment of [[Diabetic Ketoacidosis]]?

			==Conclusion==
			{{EBQ Sodium Bicarbonate use in DKA conclusion}}

	==Background==		==Background==
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	===Trial 8===		===Trial 8===
	RCT of 7 Patients 3 of them received NaHco3 and showed delay ketones clearance for 6 hours compard with control<ref>Okuda Y, Adrogue HJ, Field JB, Nohara H, Yamashita K. Counterproductive effects of sodium bicarbonate in diabetic ketoacidosis. J Clin Endocrinol Metab. 1996 Jan;81(1):314-20. PubMed PMID: 8550770.</ref>		RCT of 7 Patients 3 of them received NaHco3 and showed delay ketones clearance for 6 hours compard with control<ref>Okuda Y, Adrogue HJ, Field JB, Nohara H, Yamashita K. Counterproductive effects of sodium bicarbonate in diabetic ketoacidosis. J Clin Endocrinol Metab. 1996 Jan;81(1):314-20. PubMed PMID: 8550770.</ref>

	~~==Conclusion==~~
	*No evidence supports the use of sodium bicarb in DKA, with a pH >6.9
	*However, no studies have been performed for patients with pH <6.9 and the most recent ADA guidelines recommend it for patients with pH <7.1<ref>Diabetes Care July 2009 vol. 32 no. 7 1335-1343</ref>

	==Sources==		==Sources==

Rossdonaldson1: /* Conclusion */

2014-04-29T07:20:04Z

Conclusion

← Older revision		Revision as of 07:20, 29 April 2014
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	==Conclusion==		==Conclusion==
	* No ~~Evidence~~ supports ~~its~~ use ~~for PH~~>6.9		*No evidence supports the use of sodium bicarb in DKA, with a pH >6.9
	* No studies ~~done~~ for PH<6.9		*However, no studies have been performed for patients with pH <6.9 and the most recent ADA guidelines recommend it for patients with pH <7.1<ref>Diabetes Care July 2009 vol. 32 no. 7 1335-1343</ref>
	* American Diabetic Association Recommends giving 100 mmol NaHco3 in 400 Normal saline with ~~20 Meq potassium chloride over 2 hours~~<ref>Diabetes Care July 2009 vol. 32 no. 7 1335-1343</ref>

	==Sources==		==Sources==

Rossdonaldson1: /* Pro Argument */

2014-04-29T07:17:16Z

Pro Argument

← Older revision		Revision as of 07:17, 29 April 2014
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	==Pro Argument==		==Pro Argument==
	~~Looking~~ for any ~~studies supporting its use~~...		The most recent American Diabetes Association guidelines<ref>"Hyperglycemic Crises in Diabetes" doi: 10.2337/diacare.27.2007.S94
			Diabetes Care January 2004 vol. 27 no. suppl 1 s94-s102</ref> note that:
			*"Bicarbonate use in DKA remains controversial"<ref> Barnes HV, Cohen RD, Kitabchi AE, Murphy MB: When is bicarbonate appropriate in treating metabolic acidosis including diabetic ketoacidosis? In Debates in Medicine. Gitnick G, Barnes HV, Duffy TP, et al., Eds. Chicago, Yearbook, 1990, p. 172</ref>
			*"Prospective randomized studies have failed to show either beneficial or deleterious changes in morbidity or mortality with bicarbonate therapy in DKA patients with pH between 6.9 and 7.1"<ref>Morris LR, Murphy MB, Kitabchi AE: Bicarbonate therapy in severe diabetic ketoacidosis. Ann Int Med 105:836–840, 1986</ref>
			*"No prospective randomized studies concerning the use of bicarbonate in DKA with pH values <6.9 have been reported. Given that severe acidosis may lead to a myriad of adverse vascular effects, it seems prudent that for adult patients with a pH <6.9, 100 mmol sodium bicarbonate be added to 400 ml sterile water and given at a rate of 200 ml/h. In patients with a pH of 6.9–7.0, 50 mmol sodium bicarbonate is diluted in 200 ml sterile water and infused at a rate of 200 ml/h. No bicarbonate is necessary if pH is >7.0."<ref>"Hyperglycemic Crises in Diabetes" doi: 10.2337/diacare.27.2007.S94
			Diabetes Care January 2004 vol. 27 no. suppl 1 s94-s102</ref>
			*"In the pediatric patient, there are no randomized studies in patients with pH <6.9. If the pH remains <7.0 after the initial hour of hydration, it seems prudent to administer 1–2 mEq/kg sodium bicarbonate over the course of 1 h. This sodium bicarbonate can be added to NaCl, with any required potassium, to produce a solution that does not exceed 155 mEq/l sodium. No bicarbonate therapy is required if pH is ≥7.0 (30,31)."<ref>"Hyperglycemic Crises in Diabetes" doi: 10.2337/diacare.27.2007.S94
			Diabetes Care January 2004 vol. 27 no. suppl 1 s94-s102</ref>

	==Con Argument==		==Con Argument==

Rossdonaldson1 at 05:34, 29 April 2014

2014-04-29T05:34:10Z

← Older revision		Revision as of 05:34, 29 April 2014
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	==Clinical Question==		==Clinical Question==
	What is the utility of ~~Sodium Bicarbonate~~ in the treatment of [[Diabetic Ketoacidosis]]?		What is the utility of sodium bicarbonate in the treatment of [[Diabetic Ketoacidosis]]?

	==Background==		==Background==
	Sodium bicarbonate alkalizes the blood by binding H<sup>+</sup> and converting it to water and CO<sub>2</sub>. It previously was used by some physicians in the treatment of DKA.		Sodium bicarbonate alkalizes the blood by binding H<sup>+</sup> and converting it to water and CO<sub>2</sub>. It previously was used by some physicians in the treatment of [[DKA]].

	==Pro Argument==		==Pro Argument==

Rossdonaldson1 at 05:33, 29 April 2014

2014-04-29T05:33:28Z

← Older revision		Revision as of 05:33, 29 April 2014
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	==Clinical Question==		==Clinical Question==
	~~Should~~ Sodium Bicarbonate ~~be used to treat~~ Diabetic Ketoacidosis ?		What is the utility of Sodium Bicarbonate in the treatment of [[Diabetic Ketoacidosis]]?

	==Background==		==Background==
	Sodium bicarbonate ~~is a solution which help alkalanizing~~ the blood by binding ~~the~~ H<sup>+</sup> and converting it to water and Co<sub>2</sub>. ~~Many Physicians use it to treat~~ DKA~~, but based on what ? Is there any evidence supporting its use ?~~		Sodium bicarbonate alkalizes the blood by binding H<sup>+</sup> and converting it to water and CO<sub>2</sub>. It previously was used by some physicians in the treatment of DKA.

	==Pro Argument==		==Pro Argument==
	Looking for any studies supporting its use ...		Looking for any studies supporting its use...

	==Con Argument==		==Con Argument==

Me7sn at 20:45, 22 April 2014

2014-04-22T20:45:46Z

← Older revision		Revision as of 20:45, 22 April 2014
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	[[Category:EBQ]]		[[Category:EBQ]]

	==Links==		==Helpful Links==
	http://saudiemergencymedicine.com/should-you-use-sodium-bicarbonate-in-acidosis-stop-for-a-minute/		http://saudiemergencymedicine.com/should-you-use-sodium-bicarbonate-in-acidosis-stop-for-a-minute/

Me7sn at 20:45, 22 April 2014

2014-04-22T20:45:24Z

← Older revision		Revision as of 20:45, 22 April 2014
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	==Links==		==Links==
			http://saudiemergencymedicine.com/should-you-use-sodium-bicarbonate-in-acidosis-stop-for-a-minute/

Me7sn at 20:43, 22 April 2014

2014-04-22T20:43:35Z

← Older revision		Revision as of 20:43, 22 April 2014
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	==Sources==		==Sources==
	<references/>		<references/>
	~~http://saudiemergencymedicine.com/should-you-use-sodium-bicarbonate-in-acidosis-stop-for-a-minute/~~
	[[Category:EBQ]]		[[Category:EBQ]]

	==Links==		==Links==