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

Content Provider	Europe PMC
Author	Patel, Mit P Ahmed, Ali Gunapalan, Tharini Hesselbacher, Sean E
Copyright Year	2018
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.
Related Links	https://europepmc.org/backend/ptpmcrender.fcgi?accid=PMC6242725&blobtype=pdf
Journal	World Journal of Diabetes [World J Diabetes]
Volume Number	9
DOI	10.4239/wjd.v9.i11.199
PubMed Central reference number	PMC6242725
Issue Number	11
PubMed reference number	30479686
e-ISSN	19489358
Language	English
Publisher	Baishideng Publishing Group Inc
Publisher Date	2018-11-01
Access Restriction	Open
Rights License	This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. ©The Author(s) 2018. Published by Baishideng Publishing Group Inc. All rights reserved.
Subject Keyword	Diabetic ketoacidosis Sodium bicarbonate Blood gas analysis Acidosis Ketosis Ketone bodies Hyperglycemia
Content Type	Text
Resource Type	Article
Subject	Endocrinology, Diabetes and Metabolism