In diabetic ketoacidosis, which statement about bicarbonate therapy is true?

• A. It is routinely given in all DKA cases
• B. It is never given
• C. It is indicated if pH is between 7.0 and 7.3
• D. It is indicated if arterial pH is ≤6.9

Answer: (D)

Bicarbonate therapy in diabetic ketoacidosis is reserved for severe acidemia because while correcting the pH can improve cardiac contractility and vascular response, it carries risks such as shifts in potassium (which can worsen hypokalemia) and potential complications from rapid pH changes. The best choice reflects this: bicarbonate is indicated when the arterial pH is 6.9 or lower, a threshold at which severe acidemia poses a real threat to hemodynamic stability and insulin effectiveness. For milder acidosis, fluids and insulin correction are the mainstays, and bicarbonate is not routinely used due to its potential harms. The other statements imply routine use, never use, or use at a higher pH range, which do not align with this risk‑benefit balance.