Reply To: Urine pH monitoring with HD methotrexate

  • Carie Murphy

    February 4, 2022 at 2:08 pm

    We only maintain =>7 at our institution.  We do not notify if above any particular level, such as 8.5, etc.


    Carie Murphy, MSN, RN, CPON

    Assitant Nurse Manager, Weaver 4

    Peds Hem/Onc/BMT Educator

    Wolfson Children’s Hospital

    800 Prudential Drive, Weaver Tower 4

    Jacksonville, FL  32207

    ( (904)202-0520



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    Original Message:
    Sent: 2/1/2022 12:30:00 PM
    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