Metabolic effects of bicarbonate in the treatment of diabetic ketoacidosis.

Hale, P J; Crase, J.; Nattrass, M.

doi:10.1136/bmj.289.6451.1035

Cited by 138 publications

(63 citation statements)

References 25 publications

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“…Adequate fluid and insulin therapy will resolve the acidosis in diabetic ketoacidosis and the use of bicarbonate is not indicated [34,35]. The acidosis may be an adaptive response as it improves oxygen delivery to the tissues by causing a right shift of the oxygen dissociation curve.…”

Section: Intravenous Bicarbonate?mentioning

confidence: 99%

“…Excessive bicarbonate may cause a rise in the carbon dioxide (CO 2 ) partial pressure in the cerebrospinal fluid and may lead to a paradoxical increase in cerebrospinal fluid acidosis [36.37]. In addition, the use of bicarbonate in diabetic ketoacidosis may delay the fall in blood lactate:pyruvate ratio and ketones when compared with intravenous 0.9% sodium chloride infusion [35]. There is some evidence to suggest that bicarbonate treatment may be implicated in the development of cerebral oedema in children and young adults [38].…”

Section: Intravenous Bicarbonate?mentioning

confidence: 99%

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Joint British Diabetes Societies guideline for the management of diabetic ketoacidosis

Savage

Dhatariya²,

Kilvert³

et al. 2011

Diabetic Medicine

291

297

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The Joint British Diabetes Societies guidelines for the management of diabetic ketoacidosis (these do not cover Hyperosmolar Hyperglycaemic Syndrome) are available in full at: This article summarizes the main changes from previous guidelines and discusses the rationale for the new recommendations. The key points are: Monitoring of the response to treatment (i) The method of choice for monitoring the response to treatment is bedside measurement of capillary blood ketones using a ketone meter.(ii) If blood ketone measurement is not available, venous pH and bicarbonate should be used in conjunction with bedside blood glucose monitoring to assess treatment response.(iii) Venous blood should be used rather than arterial (unless respiratory problems dictate otherwise) in blood gas analysers.(iv) Intermittent laboratory confirmation of pH, bicarbonate and electrolytes only.Insulin administration (i) Insulin should be infused intravenously at a weight-based fixed rate until the ketosis has resolved.(ii) When the blood glucose falls below 14 mmol ⁄ l, 10% glucose should be added to allow the fixed-rate insulin to be continued.(iii) If already taking, long-acting insulin analogues such as insulin glargine (Lantus Ò

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Section: Intravenous Bicarbonate?mentioning

confidence: 99%

Section: Intravenous Bicarbonate?mentioning

confidence: 99%

Joint British Diabetes Societies guideline for the management of diabetic ketoacidosis

Savage

Dhatariya²,

Kilvert³

et al. 2011

Diabetic Medicine

291

297

View full text Add to dashboard Cite

show abstract

“…However, since sodium bicar- bonate decreases ketone bodies including BHB 31) . More aggressive administration of sodium bicarbonate may be revalidated in severe ketoacidosis with high levels of catecholamine and BHB in the blood.…”

Section: Discussionmentioning

confidence: 99%

INHIBITORY EFFECT OF ^|^beta;-HYDROXYBUTYRIC ACID ON L-TYPE Ca2+ CURRENT UNDER ^|^beta;-ADRENERGIC STIMULATION IN GUINEA PIG CARDIAC VENTRICULAR MYOCYTES

Kurihara

Akama²,

Kimura

2012

FJMS

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: Severe ketoacidosis induces heart failure and cardiac arrest, but its mechanism is unknown. Recently, hydroxy -carboxylic acid receptor 2 (HCA 2 ) was found to be a receptor for a ketone body, β -hydroxybutyric acid (BHB), and is coupled with Gi -GTP binding protein. HCA 2 expression was reported in the guinea pig heart. Therefore, using guinea pig cardiac myocytes, we investigated effects of BHB on L -type Ca 2+ current pre -augmented with β -adrenoceptor agonist, isoproterenol under the whole -cell voltage clamp. BHB significantly reduced the Ca 2+ current preaugmented with isoproterenol. The effect of BHB was concentration dependent with IC 50 of 1.1 mM. Nicotinic acid (NA), another ligand for HCA 2 , also exerted an effect on the Ca 2+ current similar to that of BHB. The effects of BHB and NA were reduced by a specific Gi inhibitor, pertussis toxin in the pipette solution. Our results suggest that BHB activates Gi -coupled signal transduction pathway via HCA 2 in guinea pig cardiac myocytes. The HCA 2 -mediated signal transduction may be associated with ketoacidosis -induced cardiac suppression.

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“…Quanto maior o acúmulo de ácidos orgânicos, maior a queda no bicarbonato sérico e, consequentemente, mais elevado é o AG. [10][11][12][13][14] [d] Portanto, a magnitude da elevação do AG reflete a magnitude do acúmulo de ácidos orgãnicos. Com o tratamento da doença de base e a reversão das condições metabólicas responsáveis pela produção excessiva destes ácidos orgânicos, o acetato e o lactato são rapidamente convertidos em bicarbonato (sendo, por isso, considerados precursores de bicarbonato ou "bicarbonato em potencial").…”

Section: Tipos De Acidose Metabólica: Implicações Terapêuticasunclassified

Uso de bicarbonato de sódio na acidose metabólica do paciente gravemente enfermo

Rocha

2009

J. Bras. Nefrol.

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Metabolic effects of bicarbonate in the treatment of diabetic ketoacidosis.

Abstract: The effect of intravenous bicarbonate on

Cited by 138 publications

References 25 publications

Joint British Diabetes Societies guideline for the management of diabetic ketoacidosis

Joint British Diabetes Societies guideline for the management of diabetic ketoacidosis

INHIBITORY EFFECT OF ^|^beta;-HYDROXYBUTYRIC ACID ON L-TYPE Ca2+ CURRENT UNDER ^|^beta;-ADRENERGIC STIMULATION IN GUINEA PIG CARDIAC VENTRICULAR MYOCYTES

Uso de bicarbonato de sódio na acidose metabólica do paciente gravemente enfermo

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