Urinary alkalinization

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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