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Urinary Alkalinization for Salicylate Poisoning Is Infrequently Measured nor Achieved
Bernard Weigel1,2, Chanell Davis1,2, Sean M Bryant1,2
1Department of Emergency Medicine, Cook County Health, Chicago, IL; and.
American Journal of Therapeutics
|April 23, 2025
Summary
Urinary pH monitoring during salicylate poisoning treatment is often overlooked, with fewer than half of cases documented. Verbal recommendations improved adherence, highlighting a gap in clinical practice.
Area of Science:
- Toxicology
- Clinical Chemistry
Background:
- Urinary alkalinization is crucial for treating salicylate poisoning.
- Clinical guidelines mandate serial urine pH measurements.
Purpose of the Study:
- To assess the frequency of urine pH measurements in salicylate poisoning cases.
- To determine the rate of achieved urinary alkalinization with sodium bicarbonate therapy.
Main Methods:
- Retrospective analysis of 352 salicylate poisoning cases (2019-2023) managed by a poison center.
- Inclusion criteria: salicylate concentration >30 mg/dL treated with bicarbonate; exclusion: hemodialysis.
- Outcomes: urine pH documentation, frequency of measurements, and achievement of pH ≥7.5.
Main Results:
- Urine pH was documented in only 41% of cases.
- Urinary alkalinization (pH ≥7.5) was achieved in 34% of cases with documented pH.
- Higher salicylate levels and verbal recommendations increased the odds of pH measurement.
Conclusions:
- Adherence to guidelines for urine pH monitoring in salicylate poisoning is poor.
- Verbal recommendations are more effective than written guidelines for promoting pH measurement.
- Further research is needed on clinical utility and adherence barriers.
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