In diabetic ketoacidosis, bicarbonate therapy is recommended under what condition?

• A. Only if pH <6.9; otherwise not routinely recommended due to potential risks.
• B. Always used in DKA regardless of pH.
• C. If glucose is high.
• D. Never used.

Answer: (A)

Bicarbonate therapy in diabetic ketoacidosis is not routinely used; it’s reserved for the most severe acidemia. When the blood pH falls below about 6.9, some clinicians administer bicarbonate to improve hemodynamic stability and organ perfusion because the extreme acidity can impair cardiovascular function. For pH higher than that, the risks of bicarbonate—such as promoting shifts in potassium that can cause dangerous hypokalemia, potential paradoxical acidosis in the brain, and other fluid- and electrolyte disturbances—outweigh any benefit, and the acidosis typically improves with insulin and fluid therapy alone. The option that ties the indication to the threshold of pH < 6.9 reflects this targeted approach. Glucose level and “never use” are not the deciding factors; the decision hinges on how severe the acidemia is.