Critical care: bicarbonate in lactic acidosis: practice question

A Anaesthesia question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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Anaesthesia · Critical care: bicarbonate in lactic acidosis

Sample item

In septic shock with lactic acidosis, when is sodium bicarbonate suggested?

ATo improve vasopressor responsiveness at pH 7.3BRoutinely for all patients with raised lactateCFor pH of 7.2 or less with acute kidney injuryDFor any pH below 7.35

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

C. For pH of 7.2 or less with acute kidney injury

Bicarbonate does not improve haemodynamics or outcome in hypoperfusion-induced lactic acidosis at modest acidaemia. Guidelines suggest it only for severe acidaemia (pH 7.2 or lower) with acute kidney injury. Treatment focuses on the cause and perfusion.

Option by option

A. To improve vasopressor responsiveness at pH 7.3
Bicarbonate does not improve vasopressor response at this pH.
B. Routinely for all patients with raised lactate
Routine use is not supported.
C. For pH of 7.2 or less with acute kidney injury (correct)
Correct. Severe acidaemia with kidney injury is the suggested threshold.
D. For any pH below 7.35
Treating mild acidaemia is not recommended.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

Questions about this Anaesthesia question

What is the answer to this Anaesthesia question?

The best answer is C, For pH of 7.2 or less with acute kidney injury. Bicarbonate does not improve haemodynamics or outcome in hypoperfusion-induced lactic acidosis at modest acidaemia.

Why is "To improve vasopressor responsiveness at pH 7.3" not the answer?

Bicarbonate does not improve vasopressor response at this pH.

Why is "Routinely for all patients with raised lactate" not the answer?

Routine use is not supported.

Why is "For any pH below 7.35" not the answer?

Treating mild acidaemia is not recommended.

What concept does this question test?

It tests Critical care: bicarbonate in lactic acidosis in Anaesthesia. Guidelines suggest it only for severe acidaemia (pH 7.2 or lower) with acute kidney injury. Treatment focuses on the cause and perfusion.

How hard is this question?

We tag it as a multi-step question: it asks you to combine more than one idea. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Critical care: bicarbonate in lactic acidosis?

Make a table of each agent, its key advantage and its main side effect. Then use the flashcards and the other Anaesthesia questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.