Urinary alkalinization

Background

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

Indications

Salicylate overdose
- Recommended for salicylate levels >30mg/dl
Phenobarbital overdose (multidose activated charcoal is superior)
Controversial:
- Rhabdomyolysis

Contraindications

Patient unable to tolerate volume/sodium load
Hypokalemia
Renal insufficiency

Procedure

Give NaHCO3 1-2 mEq/kg IV bolus OR 3-4 mEq/kg IV infusion over 1hr
Monitor urinary pH q15-30min until pH is 7.5-8.5
Sustain alkalinization by either intermittent bolus or continuous bicarbonate infusion
Monitor serum pH (do not allow to rise above 7.5-7.55)
Monitor potassium (correct hypokalemia so that alkalinization can continue)

Complications

Volume overload
pH shifts
Hypokalemia

References

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