II. Indication: Drug Overdose with Weak Acid

III. Contraindications

IV. Mechanism

  1. Enhances urinary excretion of weak acids
  2. Traps weak acids in ionized state (ion trapping)
  3. Prevents reabsorption by renal tubules

V. Medications: 8.4% Sodium Bicarbonate Solution with Potassium

  1. Sodium Bicarbonate 100 to 150 meq (2-3 ampules of 50 meq/50 ml vial)
  2. Add 20 to 40 meq Potassium (KCl) if not hyperkalemic
    1. Hypokalemia prevents urine alkalization
  3. Dissolve in D5W to total 1 liter volume
    1. Solution will be up to 8.4% Sodium Bicarbonate (0.1 to 0.15 meq/ml)
    2. Do not exceed 0.5 meq/ml concentration

VI. Dosing

  1. Use 8.4% Sodium Bicarbonate Solution with Potassium Solution as above
  2. Administer at 2 to 4 times maintenance IV rate
    1. Adult rate will be 200 to 400 ml/hour
    2. Adults would receive 20-30 to 40-60 meq/hour
    3. Do not exceed 1 meq/kg/hour
    4. Typically given over 2-3 hours
  3. Titrate to alkalizization
    1. Keep Urine pH at 7.5 to 8.0
    2. Keep serum pH normal (>7.40 up to 7.55)
    3. Keep Urine Output at 2-5 ml/kg/hour
  4. Monitoring
    1. Follow Serum Potassium closely
    2. Correct Hypokalemia if it occurs

VII. References

  1. (2005) Lexicomp Drug Database, Pocket PC Version
  2. Aaron in Stine (1994) Emergency Med, p.419
  3. Vega (2024) Am Fam Physician 109(2): 143-53 [PubMed]

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