Limited significance of bicarbonate therapy in the treatment of diabetic ketoacidosis: a rare case report in the periphery of Nepal

碳酸氢盐疗法在治疗糖尿病酮症酸中毒中的作用有限:尼泊尔偏远地区的一例罕见病例报告

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Abstract

INTRODUCTION AND IMPORTANCE: An uncontrolled hyperglycaemia accompanied by metabolic acidosis and an increase in total body ketone, if left untreated, has the potential to develop into complications, including diabetes ketoacidosis (DKA). Management of this complication with IV hydration, IV Insulin, and potassium (KCL) maintenance is a comprehensive approach. On the contrary, bicarbonate therapy is generally not regarded as a standard treatment due to its unfavourable outcome. CASE PRESENTATION: The authors present a case of a 21-year-old female who was brought in a semiconscious state to the emergency department with complaints of pain in the abdomen, headache, and vomiting. DKA was diagnosed following the patient's symptoms and arterial blood gas analysis report. She was managed with IV fluids, IV insulin, and KCL. CLINICAL DISCUSSION: Generally, pH less than 6.8 has a poor patient survival outcome. Here, the patient presented with pH less than 6.6, where she was managed with the standard regimen without the need to administer bicarbonate therapy. CONCLUSION: DKA is a life-threatening condition that can be precipitated by non-adherence to medications and infections with IV insulin and hydration playing a pivotal role in its management while bicarbonate offers no beneficial effect.

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