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Urinary alkalinization
From WikEM
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
