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Bicarbonate therapy provided no meaningful clinical benefit in the routine management of DKA and was associated with potential harm, including worsened hyperglycemia. Consistent with current guidelines, its use should be restricted to cases of severe acidemia (pH < 6.9). Further high-quality studies are needed to clarify its role in extreme acidosis and to explore alternative buffering strategies.
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Omayer et al. (2026) studied this question.
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