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Reply To: Urine pH monitoring with HD methotrexate
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 EShulta@chw.org 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 ——————————