Urinary alkalinization: Difference between revisions
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==Indications== | ==Indications== | ||
*[[Salicylate overdose]] | *[[Salicylate overdose]] | ||
**Recommended for salicylate levels > | **Recommended for salicylate levels >30mg/dl | ||
*Phenobarbital overdose (multidose activated charcoal is superior) | *[[Phenobarbital]] overdose (multidose activated charcoal is superior) | ||
*Controversial: | *Controversial: | ||
**[[Rhabdomyolysis]] | **[[Rhabdomyolysis]] | ||
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==Contraindications== | ==Contraindications== | ||
#Patient unable to tolerate volume/sodium load | #Patient unable to tolerate volume/sodium load | ||
#Hypokalemia | #[[Hypokalemia]] | ||
#Renal insufficiency | #Renal insufficiency | ||
==Procedure== | ==Procedure== | ||
#Give NaHCO3 1-2 mEq/kg IV bolus OR 3-4 mEq/kg IV infusion over 1hr | #Give NaHCO3 1-2 mEq/kg IV bolus '''OR''' 3-4 mEq/kg IV infusion over 1hr | ||
#Monitor urinary pH q15-30min until pH is 7.5-8.5 | #Monitor urinary pH q15-30min until pH is 7.5-8.5 | ||
#Sustain alkalinization by either intermittent bolus or continuous bicarbonate infusion | #Sustain alkalinization by either intermittent bolus or continuous bicarbonate infusion | ||
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[[Category:Procedures]] | [[Category:Procedures]] | ||
[[Category:Toxicology]] | |||
[[Category:Renal]] | |||
Latest revision as of 15:56, 10 October 2019
Background
- Bicarb raises urinary pH which converts weak acids to their ionized form ("ion trap")
Indications
- Salicylate overdose
- Recommended for salicylate levels >30mg/dl
- Phenobarbital overdose (multidose activated charcoal is superior)
- Controversial:
Contraindications
- Patient unable to tolerate volume/sodium load
- Hypokalemia
- Renal insufficiency
Procedure
- Give NaHCO3 1-2 mEq/kg IV bolus OR 3-4 mEq/kg IV infusion over 1hr
- Monitor urinary pH q15-30min until pH is 7.5-8.5
- Sustain alkalinization by either intermittent bolus or continuous bicarbonate infusion
- Monitor serum pH (do not allow to rise above 7.5-7.55)
- Monitor potassium (correct hypokalemia so that alkalinization can continue)
Complications
- Volume overload
- pH shifts
- Hypokalemia