Daily Bolus of LR: Bicarbonate in DKA

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May 20, 2011 by dailybolusoflr

Use of Sodium Bicarbonate in DKA


DKA by definition is defined as a state of keto-acidosis.  One of the measures of severity of DKA is the degree of acidosis that is present.


The use of sodium bicarbonate as a treatment for acidosis has been a controversial topic in the literature.


There is general consensus that for patients with pH> 7.0 the use of bicarbonate is not indicated.  Use of insulin is typically adequate to block lipolysis and ketone production. 


There is debate for patients with a pH< 7.0.


·         The following are reasonable guidelines:

·         Ensure adequate hydration bolus of normal saline (typically after about 1 hour of hydration) and obtain a repeat pH

o   If the pH is less than either 6.9 or 7.0 (depending on where you decide the cut off should be)

§  Two acceptable methods in the literature are:

·         2 mEq/kg of HCO3 added into 1L of NS to run over an hour

·         50mEq HCO3 added to 1L NS over an hour



Bicarbonate will further lower the serum potassium, which is already an electrolyte that can be depleted in this state.  You should check potassium q2hours.

Some authors support empiric administration of 20mEq of KCL in the bag



Diabetes Care January 2004 vol. 27 no. suppl 1 s94-s102

Diabetes Care December 2006 vol. 29 no. 12 2739-2748


Linda Regan, MD FACEP

Program Director, Emergency Medicine Residency

Johns Hopkins Medical Institutions


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