Urinary alkalinization

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Background

  • Bicarb raises urinary pH which converts weak acids to their ionized form ("ion trap")

Indications

  1. Salicylate overdose (recommended in moderately severe ingestions)
  2. Phenobarbital overdose (multidose activated charcoal is superior)

Contraindications

  1. Pt unable to tolerate volume/sodium load
  2. Hypokalemia
  3. Renal insufficiency

Procedure

  1. Give NaHCO3 1-2 mEq/kg IV bolus OR 3-4 mEq/kg IV infusion over 1hr
  2. Monitor urinary pH q15-30min until pH is 7.5-8.5
  3. Sustain alkalinization by either intermittent bolus or continuous bicarbonate infusion
  4. Monitor serum pH (do not allow to rise above 7.5-7.55)
  5. Monitor potassium (correct hypokalemia so that alkalinization can continue)

Complications

  1. Volume overload
  2. pH shifts
  3. Hypokalemia

Source

Tintinalli

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