Bicarbonate in diabetic ketoacidosis - a systematic review.

Détails

ID Serval
serval:BIB_426B271E5A09
Type
Article: article d'un périodique ou d'un magazine.
Collection
Publications
Titre
Bicarbonate in diabetic ketoacidosis - a systematic review.
Périodique
Annals of Intensive Care
Auteur(s)
Chua H.R., Schneider A., Bellomo R.
ISSN
2110-5820 (Electronic)
ISSN-L
2110-5820
Statut éditorial
Publié
Date de publication
2011
Peer-reviewed
Oui
Volume
1
Numéro
1
Pages
23
Langue
anglais
Notes
Publication types: Journal ArticlePublication Status: epublish
Résumé
OBJECTIVE: This study was designed to examine the efficacy and risk of bicarbonate administration in the emergent treatment of severe acidemia in diabetic ketoacidosis (DKA).
METHODS: PUBMED 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.
RESULTS: From 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.
CONCLUSIONS: The 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.
Pubmed
Open Access
Oui
Création de la notice
26/11/2014 21:54
Dernière modification de la notice
08/05/2019 17:43
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