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There has been a strong trend away from supplemental bicarbonate administration for adults with diabetic ketoacidosis (DKA), but most pediatric textbooks still recommend bicarbonate for children with DKA who have severe acidosis. These U.S. authors reviewed the care of 106 children with severe DKA (initial pH, 7.15 or lower) seen at multiple centers to assess bicarbonate's impact.
Adjunctive bicarbonate was given to 57 of the patients. These children had significantly lower pH and hemoglobin on admission than children not given bicarbonate, and had longer hospitalizations. There was no evidence that adding bicarbonate to standard care (hydration and IV insulin) changed clinical outcome after adjustment for baseline differences. Rates of meta…