View source for Urinary alkalinization

==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:
**[[Rhabdomyolysis]]

==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

==References==
<references />


[[Category:Procedures]]
[[Category:Toxicology]]
[[Category:Renal]]