Difference between revisions of "Urinary alkalinization"

(Text replacement - "OR" to "'''OR'''")
 
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*[[Salicylate overdose]]
 
*[[Salicylate overdose]]
 
**Recommended for salicylate levels >30mg/dl
 
**Recommended for salicylate levels >30mg/dl
*Phenobarbital overdose (multidose activated charcoal is superior)
+
*[[Phenobarbital]] overdose (multidose activated charcoal is superior)
 
*Controversial:
 
*Controversial:
 
**[[Rhabdomyolysis]]
 
**[[Rhabdomyolysis]]
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==Contraindications==
 
==Contraindications==
 
#Patient unable to tolerate volume/sodium load
 
#Patient unable to tolerate volume/sodium load
#Hypokalemia
+
#[[Hypokalemia]]
 
#Renal insufficiency
 
#Renal insufficiency
  
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[[Category:Procedures]]
 
[[Category:Procedures]]
 +
[[Category:Toxicology]]
 +
[[Category:Renal]]

Latest revision as of 15:56, 10 October 2019

Background

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

Indications

Contraindications

  1. Patient 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

References