ArticleAnnals of intensive care2011
Bicarbonate in diabetic ketoacidosis - a systematic review.
Article in Annals of intensive care, 2011. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT05966337 (Effects of Non-invasive Ventilation With Different Modalities in Patients Undergoing Heart Surgery), which is not on this map. Cited by 42 papers, 1 of them a synthesis that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Effects of Non-invasive Ventilation With Different Modalities in Patients Undergoing Heart Surgery: a Randomized Controlled Clinical Trial
Who cites it
42 citing papers in PubMed, 1 synthesis or guideline pooled it, 156 citations in OpenAlex.
- The Role of Bicarbonate Therapy in Diabetic Ketoacidosis: A Systematic Review and Meta-Analysis.Endocrinology, diabetes & metabolism · 2026Pooled it
- Sodium bicarbonate for "metabolic acidosis": an illustration of the Goodhart's law.Journal of intensive care · 2026Article
- Severe Hyperglycemic Crisis: A Presentation of Diabetic Ketoacidosis Requiring Intubation.Cureus · 2026Article
- Oxaliplatin-induced rhabdomyolysis in a postoperative rectal cancer patient: a case report and literature review.Frontiers in pharmacology · 2026Review
- Diabetic Ketoacidosis: Considerations and Residual Controversies in Management After the 2024 ADA, EASD, JBDS, AACE, and DST Joint ConsensusEndocrine, metabolic & immune disorders drug targets · 2026Review
- Pediatric Diabetic Ketoacidosis: Comparing Outcomes of Potassium Acetate Versus Potassium Chloride Using the Two-Bag System.The journal of pediatric pharmacology and therapeutics : JPPT : the official journal of PPAG · 2025Article
- Managing diabetic ketoacidosis in special conditions: Difficulties and dilemmas.World journal of diabetes · 2025Review
- 2025 Clinical Practice Guidelines for Diabetes Management in Korea: Recommendation of the Korean Diabetes Association.Diabetes & metabolism journal · 2025Article
- A Narrative Review on Diabetic Ketoacidosis in Children.Current pediatric reviews · 2025Review
- Complexities, Benefits, Risks, and Clinical Implications of Sodium Bicarbonate Administration in Critically Ill Patients: A State-of-the-Art Review.Journal of clinical medicine · 2024Review
- Management of diabetic keto-acidosis in adult patients admitted to intensive care unit: an ESICM-endorsed international survey.Critical care (London, England) · 2024Article
- Review
- Hyperglycaemic crises in adults with diabetes: a consensus report.Diabetologia · 2024Article
- Hyperglycemic Crises in Adults With Diabetes: A Consensus Report.Diabetes care · 2024Review
- Sodium bicarbonate and intubation in severe diabetic ketoacidosis: are we too quick to dismiss them?Clinical diabetes and endocrinology · 2024Article
- Clinical efficacy of sodium bicarbonate in treating pediatric metabolic acidosis with varying level of acid-base balance parameters: a real-world study.BMC medicine · 2023Article
- A Review of Bicarbonate Use in Common Clinical Scenarios.The Journal of emergency medicine · 2023Review
- Decompensated metabolic acidosis in the emergency department: Epidemiology, sodium bicarbonate therapy, and clinical outcomes.Critical care and resuscitation : journal of the Australasian Academy of Critical Care Medicine · 2023Article
- Case Report: Rhabdomyolysis secondary to vildagliptin overdose in a suicidal attempt: A case report and brief literature review.Frontiers in pharmacology · 2022Article
- Management of acute metabolic acidosis in the ICU: sodium bicarbonate and renal replacement therapy.Critical care (London, England) · 2021Review
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
3 authors at 2 institutions in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
objectiveThis study was designed to examine the efficacy and risk of bicarbonate administration in the emergent treatment of severe acidemia in diabetic ketoacidosis (DKA).
methodsPUBMED 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.
resultsFrom 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 < 6.85.
conclusionsThe 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.
Identifiers
What OpenQuestion holds
Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.