This is a real-world medical entrance exam question, please give the true answer based on the question and selection. Topic name: Fluids and Electrolyte Imbalance, Subject name: Medicine
What is not recommended in management of hyperkalemia? 
Select and explain. 
A. Albuterol, B. Loop diuretics, C. Peritoneal dialysis, D. 50% dextrose in water
D: 50% dextrose in water
Answer: D: 50% dextrose in water 
Explanation: Bolus D50W without insulin is never appropriate because of the risk of acutely worsening hyperkalemia due to the osmotic effect of hypeonic glucose. Intravenous bicarbonate has no role in the routine treatment of hyperkalemia. It should be reserved for patients with hyperkalemia and concomitant metabolic acidosis, and only if judged appropriate for management of the acidosis.