II. Indication: Drug Overdose with weak acid
- Phenobarbital or barbiturate Overdose
- All Class I antidysrhythmic Overdose
- Other Sodium channel blockers
- Tricyclic Antidepressant Overdose
- Antihistamine Overdose
- Cocaine Overdose
- Salicylates
- Chlorpropamide
- Chlorophenoxy Herbicides
- Sulfonamides (some)
- Methotrexate
- Fluoride Toxicity
- Diflunisal (Dolobid)
III. Mechanism
- Enhances urinary excretion of weak acids
- Traps weak acids in ionized state (ion trapping)
- Prevents reabsorption by renal tubules
IV. Preparation
- Sodium Bicarbonate 100 to 150 meq (2-3 ampules)
- Dissolve in 1 liter D5W with 20-40 meq KCl
- Works out to 0.1 to 0.15 meq/ml
- Do not exceed 0.5 meq/ml concentration
V. Dosing
- Use 0.1 to 0.15 meq/l NaHCO3 in D5W with KCl as above
- Administer at 2 to 4 times maintenance IV rate
- Adult rate will be 200 to 400 ml/hour
- Adults would receive 20-30 to 40-60 meq/hour
- Do not exceed 1 meq/kg/hour
- Typically given over 2-3 hours
- Titrate to alkalizization
- Keep Urine pH at 7.5 to 8.0
- Keep serum pH normal (>7.40)
- Keep Urine Output at 2-5 ml/kg/hour
- Monitoring
- Follow Serum Potassium closely
- Correct Hypokalemia if it occurs
VI. References
- (2005) Lexicomp Drug Database, Pocket PC Version
- Aaron in Stine (1994) Emergency Med, p.419
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| Concepts | Therapeutic or Preventive Procedure (T061) |
| SnomedCT | 243186008 |
| English | Alkaline diuresis, function, Alkaline diuresis, Alkaline diuresis, function (observable entity), Alkaline diuresis (qualifier value) |
| Spanish | diuresis alcalina (entidad observable), diuresis alcalina |
