Nephrology Book

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Urine Alkalinization

Aka: Urine Alkalinization, Urinary Alkalinization, Alkaline Diuresis
  1. See Also
    1. Sodium Bicarbonate
  2. 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. AntihistamineOverdose
    5. Cocaine Overdose
    6. Salicylates
    7. Chlorpropamide
    8. Chlorophenoxy Herbicides
    9. Sulfonamides (some)
    10. Methotrexate
    11. Fluoride Toxicity
    12. Diflunisal (Dolobid)
  3. Mechanism
    1. Enhances urinary excretion of weak acids
    2. Traps weak acids in ionized state (ion trapping)
    3. Prevents reabsorption by renal tubules
  4. 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
  5. 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
  6. References
    1. (2005) Lexicomp Drug Database, Pocket PC Version
    2. Aaron in Stine (1994) Emergency Med, p.419

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
Sources
Derived from the NIH UMLS (Unified Medical Language System)


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