Emily is a 9-year-old girl with type 1 diabetes mellitus presenting to the emergency department with severe diabetic ketoacidosis (DKA). Her medical history is notable for no prior episodes of DKA. She is currently receiving intravenous fluids and insulin therapy. The attending physician is considering adding bicarbonate therapy due to her severe acidosis (pH 6.9). Emily’s parents express concern about potential side effects of bicarbonate treatment.

Based on recent evidence, what is the most appropriate pharmacist recommendation regarding bicarbonate therapy in Emily’s management?

Jacob is a 7-year-old boy admitted for moderate diabetic ketoacidosis. His current treatment includes intravenous fluids and insulin. The clinical team is deciding between normal saline and Ringer’s lactate for fluid resuscitation. Jacob has no known allergies and no history of cardiac or respiratory disease.

Considering recent literature on fluid management in pediatric DKA, which intravenous fluid choice is most appropriate to improve acid-base status and reduce complications?

Sophia, an 11-year-old girl with type 1 diabetes, is admitted with severe DKA and signs of cardiac compromise including hypotension and poor perfusion. Her arterial blood gas shows a pH of 6.85. The medical team is debating whether to initiate bicarbonate therapy. Sophia’s parents are anxious about treatment risks and ask the pharmacist for advice.

What is the best pharmacist counseling point regarding bicarbonate therapy in this clinical context?