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--- concept_serum_alkalinization [2025/05/12 06:55] – [2. Hyperventilation] jkohts
+++ concept_serum_alkalinization [2025/08/19 06:38] (current) – jkohts
@@ Line 13: / Line 13: @@
 **Reduced free plasma concentration via protein binding**\\
-A more alkaline environment may increase drug-protein binding, reducing its free (active) fraction. For example, amitriptyline protein binding increases in an alkaline environment, reducing its free (unbound) fraction by up to 20-42% [(3004528>[[https://pubmed.ncbi.nlm.nih.gov/3004528/|PMID: 3004528]]. Levitt MA, Sullivan JB Jr, Owens SM, Burnham L, Finley PR. Amitriptyline plasma protein binding: effect of plasma pH and relevance to clinical overdose. Am J Emerg Med. 1986;4(2):121-125. doi:10.1016/0735-6757(86)90155-5)].
+A more alkaline environment may increase drug-protein binding, reducing its free (active) fraction. For example, amitriptyline protein binding increases in an alkaline environment, reducing its free (unbound) fraction by up to 20-42% [(3004528>[[https://pubmed.ncbi.nlm.nih.gov/3004528/|PMID: 3004528]]. Levitt MA, Sullivan JB Jr, Owens SM, Burnham L, Finley PR. Amitriptyline plasma protein binding: effect of plasma pH and relevance to clinical overdose. Am J Emerg Med. 1986;4(2):121-125. doi:10.1016/0735-6757(86)90155-5 {{ :levitt_1986_amitrip_plasma_protein_binding.pdf |PDF}})].
 ===== - Hyperventilation =====
-This is generally only feasible in patients who are mechanically ventilated but can be used to assist systemic alkalinization [(9737495>[[https://pubmed.ncbi.nlm.nih.gov/9737495/|PMID: 9737495]]. McCabe JL, Cobaugh DJ, Menegazzi JJ, Fata J. Experimental tricyclic antidepressant toxicity: a randomized, controlled comparison of hypertonic saline solution, sodium bicarbonate, and hyperventilation. Ann Emerg Med. 1998;32(3 Pt 1):329-333. doi:10.1016/s0196-0644(98)70009-5 {{ :mccabe_1998_tca_hts_bicarb_hyperventilation.pdf |PDF}})]. When combined with sodium bicarbonate administration, there is a risk of inducing profound alkalemia. Thus, serum pH should be closely monitored to avoid complications associated with excessive alkalinization.
+This is generally only feasible in patients who are mechanically ventilated but can be used to assist systemic alkalinization [(9737495>[[https://pubmed.ncbi.nlm.nih.gov/9737495/|PMID: 9737495]]. McCabe JL, Cobaugh DJ, Menegazzi JJ, Fata J. Experimental tricyclic antidepressant toxicity: a randomized, controlled comparison of hypertonic saline solution, sodium bicarbonate, and hyperventilation. Ann Emerg Med. 1998;32(3 Pt 1):329-333. doi:10.1016/s0196-0644(98)70009-5 {{:mccabe_1998_tca_hts_bicarb_hyperventilation.pdf|PDF}} )]. When combined with sodium bicarbonate administration, there is a risk of inducing profound alkalemia. Thus, serum pH should be closely monitored to avoid complications associated with excessive alkalinization.
+===== - Educational Resources =====
+[[https://player.vimeo.com/video/908030027?h=33d58b4b70|Video: Why all the bicarb? Pitfalls of overtreatment - A/Prof Katherine Isoardi - TAPNA ASM 2023]]