Reply To: Urine pH monitoring with HD methotrexate

  • Elissa Shulta

    February 4, 2022 at 2:06 pm

    Hi, Wendy-

    We have sodium bicarbonate in their pre-hydration fluids, so it isn’t given piggy back. Our nurses then check the pH, looking for it to be >/= 7. If the pH is higher, such as 8.5, we don’t change the amount of sodium bicarbonate that is in their pre or post-hydration fluids. If they drop below 7, we give a PRN dose of sodium bicarbonate. So we tolerate higher pHs without making any changes to the bicarb.


    Elissa Shulta, DNP,RN,CPHON
    Clinical Nurse Specialist
    Milwaukee, WI
    United States
    Original Message:
    Sent: 02-01-2022 11:30 AM
    From: Wendy Fitzgerald
    Subject: Urine pH monitoring with HD methotrexate

    Good Afternoon and happy February!

    Historically we alkalinize the urine of our patients receiving high dose methotrexate with a sodium bicarbonate drip given via piggy-back with hydration.  We monitor urine pH and if successive urine pH is > 8 (i.e. 8.5, which s generally the highest we see) we titrate the drip down by 10%.

    I am questioning if we could liberalize this and i see that COG chemotherapy guidelines only specifically recommend maintaining pH >/= 7.

    Do any institutions out there tolerate higher pHs without adjusting the alkalinization?


    Wendy Fitzgerald, CPHON,MSN,RN
    Nurse Practitioner
    Children’s National Hospital
    Washington, DC
    United States