Pharm

Urine Alkalinization

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Urine Alkalinization, Urinary Alkalinization, Alkaline Diuresis

  • Indication
  • Drug Overdose with weak acid
  • Mechanism
  1. Enhances urinary excretion of weak acids
  2. Traps weak acids in ionized state (ion trapping)
  3. Prevents reabsorption by renal tubules
  • Preparation
  1. Sodium Bicarbonate 100 to 150 meq (2-3 ampules)
  2. Dissolve in 1 liter D5W with 20-40 meq KCl
    1. Works out to 0.1 to 0.15 meq/ml
    2. Do not exceed 0.5 meq/ml concentration
  • Dosing
  1. Use 0.1 to 0.15 meq/l NaHCO3 in D5W with KCl 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)
    3. Keep Urine Output at 2-5 ml/kg/hour
  4. Monitoring
    1. Follow Serum Potassium closely
    2. Correct Hypokalemia if it occurs
  • References
  1. (2005) Lexicomp Drug Database, Pocket PC Version
  2. Aaron in Stine (1994) Emergency Med, p.419