In adults with suspected crush injury–related hyperkalemia, what is the recommended Sodium Bicarbonate dose?

• A. Sodium Bicarbonate 1 mEq/kg IV/IO
• B. Sodium Bicarbonate 50 mEq IV/IO
• C. Sodium Bicarbonate 0.5 mEq/kg IV/IO
• D. Sodium Bicarbonate 100 mEq IV/IO

Answer: (B)

When crush injury with suspected hyperkalemia is present, giving sodium bicarbonate helps by raising blood pH and alkalinizing the urine. This shift in pH promotes potassium moving from the serum into cells and reduces the risk of kidney injury from myoglobin in rhabdomyolysis. In adults, the recommended single dose in this situation is 50 mEq given IV or IO. This amount provides effective alkalinization without the risks that come with larger, weight-based doses (such as 1 mEq/kg or 0.5 mEq/kg) or an excessively large total, like 100 mEq, which can cause fluid overload or metabolic disturbances.