In lactic acidosis, which treatment is listed as appropriate?

• A. Bicarb
• B. IV fluids
• C. Dialysis
• D. Insulin

Answer: (A)

Bicarbonate can be used as a temporary measure when lactic acidosis is causing severe acidemia and is impairing cardiac function or perfusion. The idea is to raise the pH enough to stabilize hemodynamics while you address the underlying cause (eg, improved perfusion, treating sepsis, correcting hypoxia). It’s not a cure and is used cautiously because buffering can generate CO2 and introduce other risks like fluid overload and electrolyte shifts. The primary approach remains correcting perfusion with IV fluids and treating the underlying cause. Dialysis is reserved for specific situations (renal failure, toxin clearance, severe electrolyte disturbances), and insulin isn’t a treatment for lactic acidosis itself unless there’s a separate hyperglycemic or diabetic condition.