Failure of adjunctive bicarbonate to improve outcome in severe pediatric diabetic ketoacidosis

Annals of Emergency Medicine
S M GreenG J Zimmerman


Although adjunctive intravenous bicarbonate therapy is commonly recommended for children with severe diabetic ketoacidosis (DKA), no studies assessing clinical outcome with this therapy have ever been performed. Our objective was to determine whether bicarbonate therapy influenced outcome for pediatric DKA. The study was a retrospective consecutive case series of 147 admissions for severe DKA (initial pH < or = 7.15 and glucose concentration > or = 300 mg/dL [16.7 mmol/L]) in 106 children during a 16-year period at a tertiary university medical center. Descriptive statistics were applied to the 147 admissions. The first patient admitted with DKA was then selected for each of the 106 children, and clinical and laboratory data were compared between subjects who did and did not receive bicarbonate. Multivariate and matched pair analyses were performed to control potentially confounding variables. Fifty-seven of the 147 patients admitted with DKA (39%) were successfully treated without bicarbonate, including 9 with a pH of 7.00 or less and one with a pH of 6.73. The frequency of complications was comparable between bicarbonate and nonbicarbonate groups (4% versus 2%, P = 1.00). The mean duration of hospitalization for children rece...Continue Reading


Jul 1, 1979·Diabetologia·J A LuttermanA van 't Laar
May 1, 1979·American Journal of Diseases of Children·M S Kappy, E S Lightner
Jan 1, 1979·Annual Review of Medicine·A E KitabchiL R Morris
Jul 1, 1975·The Journal of Pediatrics·R Kaye
Jun 1, 1977·The Journal of Clinical Endocrinology and Metabolism·D S Schade, R P Eaton
Dec 1, 1986·Annals of Internal Medicine·L R MorrisA E Kitabchi
Apr 1, 1987·Annals of Internal Medicine·R G Narins, J J Cohen
Nov 1, 1987·Diabetes Care·J M GuerinJ M Segrestaa
May 2, 1985·The New England Journal of Medicine·E J KraneJoseph I Wolfsdorf
Aug 1, 1973·The Journal of Pediatrics·J J Krumlik, R M Ehrlich
Apr 1, 1974·The Journal of Pediatrics·P MunkR M Ehrlich
Apr 7, 1973·The Medical Journal of Australia
Feb 11, 1971·The New England Journal of Medicine·J L OhmanG P Kozak
Oct 20, 1984·British Medical Journal·P J HaleM Nattrass
Aug 1, 1983·The American Journal of Medicine·E Lever, J B Jaspan
Mar 1, 1980·The Journal of Pediatrics·Arlan L RosenbloomW H Donnelly
Jun 1, 1980·The Journal of Pediatrics·M A BureauN Gagnon
Aug 1, 1965·Circulation Research·H H WANG, R L KATZ


Mar 27, 2001·The Journal of Emergency Medicine·M R FilbinE S Nadel
Jul 12, 2002·Anaesthesia·A Vincent
Jan 11, 2000·Critical Care Medicine·C R Kannan
Aug 27, 2004·Pediatric Critical Care Medicine : a Journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies·M Jayashree, Sunit Singhi
Jul 3, 2004·Pediatric Emergency Care·Nicole S Glaser, Nathan Kuppermann
Jan 12, 2005·Pediatric Emergency Care·Viktor Rosival
Nov 29, 2012·Pediatric Emergency Care·Dai KimuraBalagangadhar R Totapally
Oct 3, 2013·Pediatric Emergency Care·Balagangadhar R Totapally
Jan 23, 2004·Archives of Disease in Childhood·David DungerLWPES
May 13, 2004·Postgraduate Medical Journal·P English, G Williams
Nov 7, 2006·American Journal of Respiratory and Critical Care Medicine·Guillermo Bugedo, Alejandro Bruhn
Sep 13, 2011·Annals of Intensive Care·Horng Ruey ChuaRinaldo Bellomo
Jul 2, 2008·Paediatric Drugs·Nicole A Sherry, Lynne L Levitsky
Jun 7, 2008·British Journal of Anaesthesia·J M Handy, N Soni
Nov 19, 2014·TheScientificWorldJournal·María M Adeva-AndanyAlberto Domínguez-Montero
Sep 3, 2013·Current Emergency and Hospital Medicine Reports·William FordCandace D McNaughton
Dec 4, 2010·Indian Journal of Pediatrics·Sindhu SivanandanRakesh Lodha
Mar 8, 2007·Pediatric Diabetes·Joseph I WolfsdorfInternational Society for Pediatric and Adolescent Diabetes
Sep 17, 2009·Pediatric Diabetes·Joseph I WolfsdorfRagnar Hanas
Jul 17, 2015·BioMed Research International·René Rodríguez-GutiérrezA Enrique Caballero
Feb 24, 2001·Diabetes Care·A E KitabchiB M Wall
May 17, 2006·The American Journal of the Medical Sciences·Mohsen S EledrisiNermeen Jaha
Jun 29, 2005·Emergency Medicine Clinics of North America·Michelle A Charfen, Madonna Fernández-Frackelton
Nov 23, 2005·Pediatric Clinics of North America·Nicole S Glaser
Jun 6, 2013·The Annals of Pharmacotherapy·Bryson DuhonDarrel W Hughes
Dec 21, 2017·BMC Pediatrics·Ke BaiMin Zhu
May 1, 2007·British Journal of Hospital Medicine·V Sharma, N Hadebe
Sep 5, 2012·Nature Reviews. Nephrology·Jeffrey A Kraut, Nicolaos E Madias
Jul 6, 2018·Case Reports in Critical Care·Hannah KinoshitaPrashant J Purohit
May 16, 2020·Nature Reviews. Disease Primers·Ketan K DhatariyaGuillermo E Umpierrez
Feb 25, 2021·The American Journal of Emergency Medicine·Brit LongMichael Gottlieb
Mar 14, 2021·Diabetes Research and Clinical Practice·Mohsen S EledrisiRayaz A Malik

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Pharmaceutical Adjuvants
Carbonic Acid Ions
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Hospital Stay
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