Which of the following is incorrrect about the use of bicarbonate in lactic acidosis?
A. Recognized complications of bicarbonate therapy include inadvertent alkalemia with reduction of cerebrospinal fluid pH and respiratory depression, severe acute hypokalemia, leftward shift of the oxyhemoglobin dissociation curve that might increase tissue hypoxia, and substantial sodium loads.
B. Bicarbonate may paradoxically increase tissue lactate production, lower intracellular pH in muscle and liver, and worsen cardiac output.
C. Those who advocate bicarbonate therapy generally suggest that it be used in amounts that correct the acidosis only partially.
D. Bicarbonate is generally recommended when arterial pH is less than 7.30.
Answer: D
Bicarbonate is not generally recommended at all unless the arterial pH is less than 7.05. In certain circumstances, its routine use is particularly discouraged.