When someone takes an overdose of a drug that is a carboxylic acid, then its buildup in the plasma can contribute to a borderline acidotic metabolic problem (due to whatever derangement of metabolism) and contribute to the overall metabolic acid build up in plasma and precipitate an acute metabolic acidosis (characterized diagnostically by a large anion gap - in case you know what this is).
Can you think of a way to accelerate the excretion of the acid drug and save the patient from serious trouble?
Hey, I am disappointed nobody made an effort to think of, or find, and answer to this important question: What you have to do is to alkalanize the urine! The acid will move o the most alkaline compartment in the body - and the urine ultimately is the one that is least regulated to resist any extremes: NOW the question is, how do you alkalanize the urine? You have to know this. What is the answer that each of you has to know (you may need this information on your first day in the ER)!
ReplyDeleteI had to use a web source to help with this (cystinuria.com):
ReplyDeleteYou can alkalinize your urine by decreasing the amount of acid you take in (eating less animal protein). You can also take in more base to alkalinize your urine (eating more fruits and vegetables). You can also intake citrate and bicarb. Potassium citrate is preferable to sodium citrate preparations because sodium may increase cystine excretion. Sodium bicarbonate comes as baking soda and in pill form. Sodium citrate can be taken as Bicitra, Shoal’s solution. Polycitra (NOT the same thing as Polycitra-K!) has both sodium citrate and potassium citrate in it. All three contain sodium citrate and citric acid. Potassium citrate comes in various preparations. Polycitra-K comes as a liquid and in crystals (packets) that you mix in water. Another option is K-Lyte which comes as an effervescent tablet that dissolves in water, like an Alka-Seltzer. (You DON'T want K-Lyte/Cl which is potassium chloride and has no alkalinizing property). Another popular form of potassium citrate is Urocit-K, a pill form.
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ReplyDeleteAlright: Oral agents and nutrition, including Na-bicarbonate pills, would be quite inadequate to deal with an urgent emergency of drug toxicity. Thus intravenous infusion of Na-bicarbonate is required and that will elevate the urinary pH to about 7.5-7.8 and accelerate clearance of some, but not all, acidic substances - in cases where intoxication is not too severe. Aspirin and methotrexate are examples. Otherwise, in severe cases, hemodialysis would be required. There is a recent position paper on this in the J. Toxicol: http://www.eapcct.org/publicfile.php?folder=congress&file=PS_UrineAlkalinization.pdf
ReplyDeleteHB
Not sure where to post this, but I found a nice resource that I would like to share. Below is a link for an explaination on "Drug permeation: the influence of pH on solubility in water and lipid".
ReplyDeletehttp://www.unpopularmedicine.com/files/Pharmacology/Basic%20concepts%20in%20pharmacology/Pharmacology%20-%20Pharmacokinetics%20-%20The%20influence%20of%20pH%20on%20solubility%20in%20water%20and%20lipid.pdf