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

Table 2 Key findings and conclusions regarding the use of sodium bicarbonate in diabetic ketoacidosis

Sodium bicarbonate use in mild to moderate acidemia (pH ≥ 7.0) is associated with

No benefit in mortality or duration of hospitalization[12]

Possible transient benefit in reversal of acidosis[12,14,16]

Delay in resolution of ketosis[18]

Trend toward worsening of central nervous system acidosis[15]

Increased need for potassium supplementation[16]

Worsened tissue hypoxia[19]

Cerebral edema and prolonged hospitalization in pediatric patients[12]

Post-treatment metabolic alkalosis

Sodium bicarbonate use in severe acidemia (pH < 7.0) has not been well-studied

No improvement in morbidity or mortality in a small, randomized trial[15]

Routine use of sodium bicarbonate in diabetic ketoacidosis is not supported by the available literature

Several situations exist in which the use of sodium bicarbonate may be warranted

Severe acidosis

Life-threatening hyperkalemia

Recovery from saline-induced metabolic acidosis