(NO) Bicarb in dka
The use of bicarb is already not recommended in pediatric DKA (advised against in most recent guidelines), but I guess these authors wanted to reeeaaally make sure we shouldn't be using it. What did they do? They looked at a database (TRINEX) that contains a bunch of de-indentified EHR data. They essentially matched 211 pairs of pediatric patients with DKA, half of whom got bicarb while the other half did not.
What did they find? Nothing good for fans of bicarb. Coma, pulmonary edema and respiratory failure were all statistically more likely in patients treated with bicarb.
Notably, the absolute number of patients with these key outcomes was small. But still, statistically more likely in the patients treated with bicarb. Also, they did not find a difference in the incidence of cerebral edema and death between the 2 groups.
Flaws? This is a retrospective propensity matched study. They do a good job of matching the bicarb group and the no-bicarb group, but in a retrospective review like this, they can only look at the data that was available in the database, and confounding from unmeasured variables is likely. (We don't know what pH for any of these kids was, so it's possible one group was much sicker than the other)
Bottom Line: this study confirms that we should continue to not be using bicarb in pediatric DKA
What did they find? Nothing good for fans of bicarb. Coma, pulmonary edema and respiratory failure were all statistically more likely in patients treated with bicarb.
Notably, the absolute number of patients with these key outcomes was small. But still, statistically more likely in the patients treated with bicarb. Also, they did not find a difference in the incidence of cerebral edema and death between the 2 groups.
Flaws? This is a retrospective propensity matched study. They do a good job of matching the bicarb group and the no-bicarb group, but in a retrospective review like this, they can only look at the data that was available in the database, and confounding from unmeasured variables is likely. (We don't know what pH for any of these kids was, so it's possible one group was much sicker than the other)
Bottom Line: this study confirms that we should continue to not be using bicarb in pediatric DKA
