Which finding in a child with diabetic ketoacidosis constitutes the generally accepted indication for administration of intravenous sodium bicarbonate?
- A Serum bicarbonate below 12 mEq/L
- B Venous pH below 7.2
- C Arterial pH below 6.9 with hemodynamic compromise ✓
- D Base deficit greater than 10 mEq/L
Correct answer: C. Arterial pH below 6.9 with hemodynamic compromise
Explanation
Routine bicarbonate is avoided in pediatric DKA because it paradoxically worsens central nervous system acidosis, accelerates hypokalemia, and may promote cerebral edema. It is considered only in life-threatening acidosis, classically pH below 6.9 with cardiac compromise or extreme hyperkalemia. A pH of 7.2 or base deficit alone never justifies bicarbonate; such children are managed with fluids, insulin, and potassium replacement.
Reference: Nelson Textbook of Pediatrics, 21st ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.