Urinary Alkalinization: Out of Favor?

 

Historically a mainstay of TLS prevention, the use of IV sodium bicarbonate to alkalinize the urine has become controversial. Adding sodium bicarbonate to IV fluids raises the patient's urine pH above,7 increasing excretion of uric acid.5 When the uric acid level returns to normal, alkalinization is stopped. However, an alkaline environment can promote calcium and phosphorus precipitation and promote renal failure, as well as metabolic alkalosis. When used with allopurinol, alkalinization can also interfere with xanthine and hypoxanthine solubility and promote urinary xanthine crystal deposits in the kidneys. For these reasons, routine alkalinization is no longer recommended, although some practitioners still order it.