Bicarbonate in diabetic ketoacidosis - a systematic review

Annals of Intensive Care

Table 2 Summary of bicarbonate dose administered in case series and studies

Reference	Nature of Study	Dose of bicarbonate given (mean)			Dose Estimation	Timing (range)
		Conc (%)	Total (mM)	Wt-adj (mM/kg)
Addis 1964 [29]	CS	8.4	413	NR	based on calculated dose	150 initial, and rest
						over 1.5 to 12 hr
Kuzemko 1969 [30]^P	CS	8.4	255	NR	based on calculated dose	over 3 to 32 hr
Zimmet 1970 [4]	CS	NR	185	NR	based on pH severity	within initial 4 hr
					(≈ half of calculated dose)
Soler 1972 [22]^AP	PrC	1.0	200 - 400^†	NR	NR	NR
Krumlik 1973 [31]^P	CS	7.5	115 (3.3/kg) to reach pH ≥ 7.2		based on calculated dose	half over 30 min,
			144 (3.9/kg) to reach pH ≥ 7.3			rest over 2 hrs
Munk 1974 [16]^P	PrC	NR	130	2.44	NR	NR
Assal 1974 [23]^AP	ReC	NR	230	NR	half of calculated dose given	within initial 4 hr
Keller 1975 [33]	CS	NR	345	NR	based on calculated dose	within initial 24 hr
Reddy 1977 [34]^P	CS	≈ 0.6	NR	2.50	slow infusion till pH > 7.2	over mean of 4.9 hr
Lutterman 1979 [17]	ReC	1.4	167	NR	standard dose for all	within initial 6 hr
Lever 1983 [18]	ReC	NR	130-135^╫	NR	NR	majority slow infusion
Hale 1984 [13]	RCT	1.3	150	NR	standard dose for all	over 1 hr
Morris 1986 [14]	RCT	NR	120	NR	titrated to pH, repeated till	intermittent dose, over
					pH > 7.15	30 min; 2 hr interval
Gamba 1991 [15]	RCT (DB)	≈ 7.5	84	NR	titrated to pH, repeated till	intermittent dose, over
					pH rise > 0.05	30 min; 2 hr interval
Okuda 1996 [19]	PrC	NR	200	NR	standard dose (50 mmol/hr)	over 4 hr
Green 1998 [24]^P	ReC	NR	NR	2.08	NR	NR
Viallon 1999 [20]	ReC	1.4	120	NR	as per attending physician	over 1 hr
Latif 2002 [21]	ReC	NR	50	NR	standard dose for all	NR

CS = case series; PrC = prospective case-control; ReC = retrospective case-control; RCT = randomized controlled trial; DB = double-blind; Conc = concentration; NR = not reported; mM = mmol; Wt-adj = weight-adjusted
^†Mean values provided separately for two study arms; ^╫mean values provided separately for two study centers
^PPediatric studies; ^APmainly adults but including pediatric patients