Bicarbonate therapy in children with DKA
- Report By: Joanna Ibhadon - 4th year Medical Student
- Institution: University of Manchester
- Date Submitted: 12th July 2002
- Last Modified: 30th July 2009
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Status:
Blue (submitted but not checked)
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.Search Outcome
128 papers were found in total and 2 were selected as suitable.Relevant Paper(s)
| Author, date and country | Patient group | Study type (level of evidence) | Outcomes | Key results | Study Weaknesses |
|---|---|---|---|---|---|
| Churku Mohan Reddy and Eduardo Orti 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 |
Comment(s)
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.Clinical 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 J Natl Med Assoc 1977 May; 69(5): 355–357.