Q: Describe role of urine alkalinization in barbiturate overdose?



Answer: Alkalinization of the urine is useful for long-acting barbiturates like phenobarbital and butalbital but is not recommended for short-acting barbiturate toxicity.

Phenobarbital has a higher water solubility and slow hepatic metabolism which allow a larger proportion of drug to be renally excreted. Urinary elimination may be achieved with an initial sodium bicarbonate bolus followed by an infusion to maintain a urine pH of greater than 7.5 (watch arterial pH). The goal should be a urine output of 150-250 mL/h.