tailieunhanh - báo cáo hóa học: " Bicarbonate in diabetic ketoacidosis - a systematic review"

Tuyển tập báo cáo các nghiên cứu khoa học quốc tế ngành hóa học dành cho các bạn yêu hóa học tham khảo đề tài: Bicarbonate in diabetic ketoacidosis - a systematic review | Chua et al. Annals of Intensive Care 2011 1 23 http content 1 1 23 Ù Annals of Intensive Care a SpringerOpen Journal REVIEW Open Access Bicarbonate in diabetic ketoacidosis - a systematic review Horng Ruey Chua1 Antoine Schneider1 and Rinaldo Bellomo1 2 Abstract Objective This study was designed to examine the efficacy and risk of bicarbonate administration in the emergent treatment of severe acidemia in diabetic ketoacidosis DKA . Methods PUBMED database was used to identify potentially relevant articles in the pediatric and adult DKA populations. DKA intervention studies on bicarbonate administration versus no bicarbonate in the emergent therapy acid-base studies studies on risk association with cerebral edema and related case reports were selected for review. Two reviewers independently conducted data extraction and assessed the citation relevance for inclusion. Results From 508 potentially relevant articles 44 were included in the systematic review including three adult randomized controlled trials RCT on bicarbonate administration versus no bicarbonate in DKA. We observed a marked heterogeneity in pH threshold concentration amount and timing for bicarbonate administration in various studies. Two RCTs demonstrated transient improvement in metabolic acidosis with bicarbonate treatment within the initial 2 hours. There was no evidence of improved glycemic control or clinical efficacy. There was retrospective evidence of increased risk for cerebral edema and prolonged hospitalization in children who received bicarbonate and weak evidence of transient paradoxical worsening of ketosis and increased need for potassium supplementation. No studies involved patients with an initial pH . Conclusions The evidence to date does not justify the administration of bicarbonate for the emergent treatment of DKA especially in the pediatric population in view of possible clinical harm and lack of sustained benefits. Introduction Diabetic .