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Purpose: The use of IV bicarbonate in diabetic ketoacidosis (DKA) may be considered for patients with a pH of <6.9. The impact of this therapy on resolution of acidosis in DKA patients is unclear. The primary outcome was to compare time to resolution of acidosis (pH ≥7.20) between DKA patients who received IV bicarbonate versus those who did not.
Methods: This single-center, retrospective analysis included 86 adult DKA patients between January 2007 and July 2011. Patients were identified by a diagnosis code of DKA and included if they presented with a pH <7.0.
Results: Patients were mostly female (58%) and Hispanic (64%) with a median age of 35 (interquartile range 25 to 46 years). More patients had Type 1 diabetes mellitus (53%) compared with Type 2 (41%); of patients with Type 2 diabetes, 78% were insulin dependent. Average pH (6.86 vs. 6.97, p=0.2) and blood glucose level (560 vs. 595 mg/dL, p=0.53) at presentation were similar between bicarbonate and no bicarbonate groups. There was no significant difference in time to resolution of acidosis (8 vs. 8 hours, p=0.7) nor time to hospital discharge (68 vs. 61 hours, p=0.3). Insulin requirements in the first 24 hours were significantly higher in patients receiving IV bicarbonate versus those not receiving IV bicarbonate (100 vs. 86 units, p=0.04). There was no significant difference in hours on continuous insulin infusion (27 vs. 26 hours, p=0.09), or potassium requirements in the first 24 hours (135 vs. 120 mEq, p=0.84). Subgroup analyses of patients with initial pH<6.9 showed no difference in time to resolution of acidosis (10 vs. 12 hours, p=0.3) or hospital length of stay (68 vs. 70 hours, p=0.9).
Conclusion: IV bicarbonate therapy did not decrease time to resolution of acidosis or time to hospital discharge for DKA patients with initial pH<7.0.