Administer an intravenous bolus of 1 to 2 meq/kg sodium bicarbonate, followed by either intermittent boluses of sodium bicarbonate or a continuous intravenous infusion to achieve a urinary pH of 7.5 to 8.0. Serum pH should not be allowed to rise above 7.5 to 7.55. Pronounced hypokalemia may result from this technique and must be corrected aggressively. Hypokalemia induces the kidneys to reabsorb potassium preferentially. To remain electronegatively neutral, hydrogen ions are excreted, inhibiting the production of an alkaline urine. This may result in a paradoxically acidic urine.
The benefit of urinary alkalinization is a decrease in toxin serum half-life from increased urinary excretion. The risks include congestive heart failure, pulmonary edema, pH shifts, and profound hypokalemia. Therefore, contraindications to this procedure include patients who cannot tolerate the volume or sodium load, hypokalemia, renal insufficiency, and ingestion of a toxin that does not respond to alkalinization.
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