Which statement about bicarbonate use in hyperkalemia management is correct?

• A. It should be given to all hyperkalemia patients
• B. It should be avoided in CKD patients
• C. It should be used only if acidosis is present
• D. It may be used if acidosis is present

Answer: (D)

Bicarbonate helps in hyperkalemia by correcting metabolic acidosis, which promotes potassium to move from the blood into cells, lowering serum potassium. This effect relies on the presence of acidosis: when pH is low, H+ enters cells in exchange for K+, raising serum K+. Giving bicarbonate raises pH, reduces H+ influx, and encourages K+ to shift intracellularly, making the potassium-lowering effect most relevant in patients who actually have acidosis (a common situation in CKD). Because the benefit depends on there being acidosis, bicarbonate isn’t indicated for all hyperkalemia cases and can cause volume or sodium overload if given inappropriately. Therefore, it may be used if acidosis is present, which is why that option is the best choice.