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Urine Alkalinization

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Urine Alkalinization, Urinary Alkalinization, Alkaline Diuresis

  • See Also
  1. Sodium Bicarbonate
  • Indication
  • Drug Overdose with Weak Acid
  1. Phenobarbital or BarbiturateOverdose
  2. All Class I antidysrhythmic Overdose
    1. Other Sodium Channel BlockerOverdose
  3. Tricyclic Antidepressant Overdose
  4. Antihistamine Overdose
  5. Cocaine Overdose
  6. Salicylate Overdose
  7. Chlorpropamide
  8. Chlorophenoxy Herbicides
  9. Sulfonamides (some)
  10. Methotrexate
  11. Fluoride Toxicity
  12. Diflunisal (Dolobid)
  • Contraindications
  1. Renal Failure
  2. Pulmonary Edema
  3. Cerebral edema
  • Mechanism
  1. Enhances urinary excretion of weak acids
  2. Traps weak acids in ionized state (ion trapping)
  3. Prevents reabsorption by renal tubules
  1. Sodium Bicarbonate 100 to 150 meq (2-3 ampules of 50 meq/50 ml vial)
  2. Add 20 to 40 meq Potassium (KCl) if not hyperkalemic
    1. Hypokalemia prevents urine alkalization
  3. Dissolve in D5W to total 1 liter volume
    1. Solution will be up to 8.4% Sodium Bicarbonate (0.1 to 0.15 meq/ml)
    2. Do not exceed 0.5 meq/ml concentration
  • Dosing
  1. Use 8.4% Sodium Bicarbonate Solution with Potassium Solution 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 up to 7.55)
    3. Keep Urine Output at 2-5 ml/kg/hour
  4. Monitoring
    1. Follow Serum Potassium closely
    2. Correct Hypokalemia if it occurs
  • References
  1. (2005) Lexicomp Drug Database, Pocket PC Version
  2. Aaron in Stine (1994) Emergency Med, p.419
  3. Vega (2024) Am Fam Physician 109(2): 143-53 [PubMed]