Bicarbonate therapy in children with DKA

Date First Published:

July 12, 2002

Last Updated:

July 30, 2009

Report by:

Joanna Ibhadon, 4th year Medical Student (University of Manchester)

Three-Part Question:

In a [child with DKA], what [degree of acidosis] is necessary to [commence bicarbonate therapy]?

Clinical Scenario:

A 14 year old male is under your care and being treated for diabetic ketoacidosis. Fluid resuscitation occurred and insulin was commenced. However, his blood gases continue to reveal a severe degree of acidaemia (pH<6.9). You wonder whether this patient will benefit from bicarbonate therapy and if there is any evidence to prove its efficacy.

Search Strategy:

Medline (1950-07/09) using the OVID interface, Cochrane (2009) and Embase (2009) [exp.Bicarbonates] AND [exp.Diabetic ketoacidosis]. LIMIT to human AND children aged 0-18 AND English language.

Outcome:

128 papers were found in total and 2 were selected as suitable.

Relevant Paper(s):

Study Title	Patient Group	Study type (level of evidence)	Outcomes	Key results	Study Weaknesses
Insulin and Sodium Bicarbonate Treatment of Diabetic Ketoacidosis in Children Viallon, Alain MD; 1999 France	Nineteen patients, nine males and ten females with 24 episodes of diabetic ketoacidosis	Case study		Ketoacidosis was corrected with 2.5mEq of sodium bicarbonate/kg of body weight.	-Small sample size

Author Commentary:

Biicarbonate therapy does not affect
oxygen transport in juvenile diabetic
ketoacidosis. However, very low pH
has adverse effects on the respiratory
center1 and on myocardial contractility.

Bottom Line:

Bicarbonate therapy is only indicated in the managemenet of diabetic ketoacidosis in children with severe acidosis(pH<6.9)and after discussion with senior.

References:

Viallon, Alain MD;. Insulin and Sodium Bicarbonate Treatment of Diabetic Ketoacidosis in Children