II. Indication: Drug Overdose with weak acid

  1. Phenobarbital or barbiturate Overdose
  2. All Class I antidysrhythmic Overdose
    1. Other Sodium channel blockers
  3. Tricyclic Antidepressant Overdose
  4. Antihistamine Overdose
  5. Cocaine Overdose
  6. Salicylates
  7. Chlorpropamide
  8. Chlorophenoxy Herbicides
  9. Sulfonamides (some)
  10. Methotrexate
  11. Fluoride Toxicity
  12. Diflunisal (Dolobid)

III. Mechanism

  1. Enhances urinary excretion of weak acids
  2. Traps weak acids in ionized state (ion trapping)
  3. Prevents reabsorption by renal tubules

IV. Preparation

  1. Sodium Bicarbonate 100 to 150 meq (2-3 ampules)
  2. Dissolve in 1 liter D5W with 20-40 meq KCl
    1. Works out to 0.1 to 0.15 meq/ml
    2. Do not exceed 0.5 meq/ml concentration

V. Dosing

  1. Use 0.1 to 0.15 meq/l NaHCO3 in D5W with KCl as above
  2. Administer at 2 to 4 times maintenance IV rate
    1. Adult rate will be 200 to 400 ml/hour
    2. Adults would receive 20-30 to 40-60 meq/hour
    3. Do not exceed 1 meq/kg/hour
    4. Typically given over 2-3 hours
  3. Titrate to alkalizization
    1. Keep Urine pH at 7.5 to 8.0
    2. Keep serum pH normal (>7.40)
    3. Keep urine output at 2-5 ml/kg/hour
  4. Monitoring
    1. Follow Serum Potassium closely
    2. Correct Hypokalemia if it occurs

VI. References

  1. (2005) Lexicomp Drug Database, Pocket PC Version
  2. Aaron in Stine (1994) Emergency Med, p.419

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Ontology: Alkaline diuresis (C0419063)

Concepts Therapeutic or Preventive Procedure (T061)
SnomedCT 243186008
English Alkaline diuresis, function, Alkaline diuresis, Alkaline diuresis, function (observable entity), Alkaline diuresis (qualifier value)
Spanish diuresis alcalina (entidad observable), diuresis alcalina