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October 6, 1978

Regimen for Alkalinization of Urine

JAMA. 1978;240(15):1588. doi:10.1001/jama.1978.03290150034016

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To the Editor.—  In QUESTIONS AND ANSWERS (239:2385, 1978) Donald R. Bennett, MD, PhD, described the recommended daily dosage for a healthy 70-kg adult of sodium bicarbonate taken daily as a urine alkalinizer. He mentioned the usual dosage range of 325 mg to 2 g, one to four times daily, with a maximum total daily dosage of 16 g. He very properly specified great caution with these dosages in patients with "edematous sodium-retaining states."In many years of alkalinizing the urine of patients with lymphoma (in pre-allopurinol days) undergoing lympholytic chemotherapy with attendant hyperuricemia and hyperuricuria, I have successfully followed the dosage plan recommended by Dr Bennett with the exception that acetazolamide, 0.5 to 1.0 g, is prescribed at bedtime. Through inhibition of carbonic anhydrase, this leads to renal secretion of the sodium ion that has been administered during the day, thus achieving sodium balance and alkalinization of the urine