SAT-642 The Role of Bicarbonate Therapy in Diabetic Ketoacidosis Patients: A Systematic Review and Meta-analysis of the Literature

Abstract Disclosure: A. Omayer: None. A. Sharif: None. A. Kc: None. S. Hoque: None. H. BaniHani: None. L. Khaled: None. A. Holeihel: None. U.A. Khawaja: None. Background: Diabetic ketoacidosis (DKA) is a life-threatening complication of diabetes mellitus that is often managed with fluid resuscitation, insulin therapy, and correction of electrolyte imbalances. Bicarbonate therapy is commonly used to correct acidosis, but its effectiveness remains debated. This systematic review and meta-analysis aimed to assess the impact of bicarbonate therapy on clinical outcomes in DKA patients. Methods: Following the PRISMA guidelines, we performed a systematic review of studies assessing the use of bicarbonate therapy in DKA. We searched PubMed, Google Scholar, Cochrane Library, and ClinicalTrials.gov for studies published up to August 2024. Studies were included if they involved DKA patients with initial pH ≤7.30 or glucose >250 mg/dL, and compared bicarbonate therapy with standard care. Data on outcomes were extracted, including pH levels, duration of hospital stay, time to resolution of acidosis, potassium levels, and incidence of hypoglycemia. We performed a meta-analysis using RevMan, with a random-effects model for most outcomes and fixed-effects for specific analyses. The risk of bias was assessed using the Newcastle-Ottawa Scale (NOS), Cochrane's ROB-2 tool and The Joanna Briggs Institute (JBI) Scale for cohort studies, randomized controlled trials (RCTs) and case series respectively. Results: Eight studies, including 646 patients, met the inclusion criteria. The included studies were conducted in various countries and represented diverse populations, with sample sizes ranging from 20 to 232 participants. Participants' mean ages spanned from approximately 9.7 years to 45.8 years. The proportion of male participants varied significantly, from 40.6% to 54.3%. Bicarbonate therapy did not significantly improve pH levels (mean difference = -0.02, 95% CI [-0.13, 0.09], p = 0.7), time to resolution of acidosis (mean difference = 0.09 hours, 95% CI [-2.6, 2.79], p = 0.95), or potassium levels (mean difference = -0.10, 95% CI [-0.49, 0.29], p = 0.61). Bicarbonate therapy was associated with a marginally longer duration of hospital stay (mean difference = 13.63 hours, 95% CI [0.23, 27.03], p = 0.05), although the overall effect size was small. No significant difference was observed in the incidence of hypoglycemia (odds ratio = 2.62, 95% CI [0.59, 11.63], p = 0.20). High heterogeneity was observed across most outcomes, mainly due to variability in study protocols and patient populations. Conclusion: Bicarbonate therapy in DKA does not appear to provide significant clinical benefits in pH correction, resolution of acidosis, or potassium balance and may lead to a slightly prolonged hospital stay. Given the high heterogeneity of included studies, further well-designed trials are needed to establish more precise guidelines on bicarbonate use in DKA management. Presentation: Saturday, July 12, 2025