Target of Urine PH in Salicylate toxicity

Q: In Salicylate toxicity what is the target of Urine PH?

Answer: 8

Renal elimination of salicylate can be achieved by alkaline diuresis to increase urine pH, ideally to more than/= 8. Alkaline diuresis is indicated for patients with any symptoms of poisoning and should not be delayed until salicylate levels are determined. This intervention is safe and exponentially increases salicylate excretion. Because hypokalemia may interfere with alkaline diuresis, patients are given a solution consisting of 1 L of 5% D/W, with 3 (50-mEq) ampules of NaHCO3, and 40 mEq of KCl. Serum K should be monitored closely.

Intensivists should also remember that there is always a risk of rebound salicylate toxicity following cessation of urine alkalinization. 

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References:

1. American College of Medical Toxicology. Guidance document: management priorities in salicylate toxicity. J Med Toxicol. 2015 Mar;11(1):149-52. doi: 10.1007/s13181-013-0362-3. PMID: 25715929; PMCID: PMC4371029.

2. O'Keefe M, Stanton M, Feldman R, Theobald J. Incidence of rebound salicylate toxicity following cessation of urine alkalinization. Clin Toxicol (Phila). 2023 Jul;61(7):536-542. doi: 10.1080/15563650.2023.2227998. Epub 2023 Jul 10. PMID: 37427892.