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

Table 3 Key findings and conclusions regarding blood gas monitoring in diabetic ketoacidosis

Venous blood is similar to arterial sampling in measuring

pH[21-25]

Bicarbonate[21,24]

Lactate[21]

Base excess[21]

Venous blood gas measurement may be used in place of arterial blood for the purposes of stratifying disease severity in diabetic ketoacidosis

Blood gas measurement does not often change management of diabetic ketoacidosis, especially when routine chemistries (including bicarbonate level) and ketone body identification are available[25]

Routine use of arterial and/or venous blood gas measurement may not be necessary in the evaluation and management of diabetic ketoacidosis

Exceptions where blood gas analysis would likely alter management include

Abnormal baseline serum bicarbonate levels

Chronic respiratory failure

Renal tubular acidosis

Acute respiratory compromise

Adequacy of respiratory compensation for metabolic acidosis

Respiratory muscle fatigue and failure