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Bicarbonate in diabetic ketoacidosis – a systematic review
Sodium bicarbonate use in the management of diabetic ketoacidosis is a topic of controversy, with varying recommendations and evidence.
A systematic review was conducted to analyze studies comparing bicarbonate administration to no bicarbonate in DKA.
While bicarbonate showed transient acidosis improvement within 2 hours, no significant glycemic control benefits were observed. Bicarbonate use was associated with increased risk of cerebral edema, hypokalemia, prolonged hospitalization in children, and paradoxical ketosis worsening. Notably, no studies included patients with initial pH below 6.85.
In conclusion, current evidence does not support routine bicarbonate use in DKA due to potential harm and lack of sustained benefits, especially in pediatric cases.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3224469/