Urinary alkalinization: Difference between revisions
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==Indications== | ==Indications== | ||
*[[Salicylate overdose]] | *[[Salicylate overdose]] | ||
**Recommended for salicylate levels >30 mg/dl | |||
*Phenobarbital overdose (multidose activated charcoal is superior) | *Phenobarbital overdose (multidose activated charcoal is superior) | ||
*Controversial: | *Controversial: | ||
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#Hypokalemia | #Hypokalemia | ||
== | ==References== | ||
<references /> | |||
Tintinalli | Tintinalli | ||
[[Category:Procedures]] | [[Category:Procedures]] | ||
Revision as of 00:11, 21 June 2015
Background
- Bicarb raises urinary pH which converts weak acids to their ionized form ("ion trap")
Indications
- Salicylate overdose
- Recommended for salicylate levels >30 mg/dl
- Phenobarbital overdose (multidose activated charcoal is superior)
- Controversial:
Contraindications
- Pt 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
References
Tintinalli