What is the dose and route for sodium bicarbonate in the hyperkalemia protocol?

• A. 50 mEq slow IVP/IO
• B. 50 mEq rapid IVP
• C. 25 mEq slow IVP
• D. 100 mEq slow IVP/IO

Answer: (A)

In hyperkalemia management, sodium bicarbonate is used to correct acidosis and push potassium into cells by shifting hydrogen ions out of cells in exchange for potassium. The standard prehospital dose is 50 mEq, given slowly by IV push or through an IO line. This amount achieves the desired alkalinizing effect without the risks of a rapid bolus, and the IO route is available if IV access isn’t yet established. A rapid administration or a much larger dose increases risks such as fluid overload and electrolyte imbalance, while a smaller dose may not produce the needed shift of potassium.