Does bicarbonate therapy improve the management of severe diabetic ketoacidosis?

Objective: The use of bicarbonates in the treatment of severe diabetic keto acidosis remains controversial, especially regarding the benefit/risk ratio . The aim of this study was to assess the efficacy of bicarbonate therapy d uring severe diabetic ketoacidosis (pH < 7.10). Design: Retrospective study. Setting: The emergency unit of a teaching hospital. Patients: The records of 39 patients consecutively admitted for severe diab etic ketoacidosis were analyzed (pH < 7.10). The patients were divided into two groups: group 1 (n = 24; patients with bicarbonate treatment) and grou p 2 (n = 15; patients without bicarbonate treatment). Interventions: None. Measurements and Main Results: We compared two groups of patients presentin g with severe diabetic ketoacidosis (pH values between 6.83 and 7.08) treat ed with or without bicarbonate, A group of 24 patients received 120 +/- 40 mmol sodium bicarbonate, The two groups were similar at admission with rega rd to clinical and biological parameters. No difference could be demonstrat ed between the two groups concerning the clinical parameters or the normali zation time of biochemical parameters. If the number of patients with hypok alemia was comparable between the two groups, the potassium supply was sign ificantly more important in group 1 compared with group 2 (366 +/- 74 mmol/ L vs. 188 +/- 109 mmol/L, respectively; p < .001). Conclusions: Data from the literature and this study are not in favor of th e use of bicarbonate in the treatment of diabetic ketoacidosis with pH valu es between 6.90 and 7.10.