Which statement is true about the use of bicarbonate in DKA therapy?

• A. Bicarbonate is never used in DKA.
• B. Bicarbonate is only used in mild acidosis.
• C. Bicarbonate is indicated in severe acidosis.
• D. Bicarbonate is given to prevent any acidosis.

Answer: (C)

In DKA, bicarbonate therapy is reserved for severe acidemia. The primary treatment is IV fluids, insulin, and careful correction of electrolytes, which typically improves acidosis without bicarbonate. Bicarbonate is considered only when the arterial pH falls to about 6.9 or lower, because at that level the risks of ongoing severe acidosis (such as hemodynamic instability) may outweigh the potential benefits of raising the pH. When used, bicarbonate can help improve perfusion, but it carries risks like driving potassium into cells (leading to hypokalemia), fluid overload, and, in children, a risk of cerebral edema. It does not prevent acidosis from developing and is not routinely given for mild or moderate acidosis.