Urinary alkalinization: Difference between revisions
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==Indications== | ==Indications== | ||
*[[Salicylate overdose]] (recommended in moderately severe ingestions) | |||
*Phenobarbital overdose (multidose activated charcoal is superior) | |||
*Controversial: | |||
**[[Rhabdomyolysis]] | |||
==Contraindications== | ==Contraindications== | ||
Revision as of 21:19, 21 January 2015
Background
- Bicarb raises urinary pH which converts weak acids to their ionized form ("ion trap")
Indications
- Salicylate overdose (recommended in moderately severe ingestions)
- 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
Source
Tintinalli