medicine urinary system acidifier&alkalizer.pptx

medicine urinary system acidifier&alkalizer.pptx

• 1.
  Drugs acting onurinary system: Acidifier and alkalizer B.N/Bsc
• 2.
  Introduction • Urine isan excretory product of body secreted by the kidney. • The normal pH of urine ranges from 4.5-7.5 (mostly 6.6) • Urine pH changes, depending on diet, certain disease processes and the medications. • The kidney maintain normal acid base balance primarily through the reabsorption of sodium and tubular secretion of hydrogen and ammonium ions. • Causes of acidic Urine : acidosis in blood, starvation, severe diarrhea, respiratory problems in which carbondioxide retention occur and drugs such as thiazide diuretics, ammonium chloride etc
• 3.
  Cont. • Causes ofhighly alkaline urine are • alkalosis in blood. • Chronic renal failure • Urinary tract obstruction. • Respiratory disease involving hyperventilation (increase expel of CO2 ) • Salicylate poisoning. • Drug such as sodium citrate , sodium bicarbonate, potassium citrate etc
• 4.
  Urinary Acidifier • Aurinary acidifier are agents that decrease pH of urine and makes it more acidic. • Urinary acidifiers are generally given to treat increase in urinary pH. • Similarly these are also used to dissolve certain types of stones in bladder. • Commonly used urinary acidifier • Ammonium chloride • Potassium acid phosphate • Ascorbic acid (vit C) • Citric acid/glucono-delta lactone/magnesium carbonate (renacidin)
• 5.
  Ammonium chloride • Itis white crystalline salt ,highly soluble in water and its solution is mild acidic in nature. • Pharmacological action: In liver ammonium chloride is break down in urea with liberation of hydrogen and chloride ion which increases urinary acidity. • Indication: as acidifier, as an expectorant, to prevent and treat certain uroliths. • Dosage: 5meq/ml injection • Adverse effect; acidosis, rashes, ECG abnormalities • Contraindications: Severe hepatic or renal impairment, cardiac failure
• 6.
  Potassium acid phosphate •Commonly use urinary acidifier. • Beside urinary acidifier it is also important in nerve impulses transmission, glucose utilization, muscle contractions, and enzyme activity. • Indication: To treat urinary alkalosis • Dosage : Tablet 500mg dissolve in 1 glass of water and given TDS or QID • Adverse effect: diarrhea, Nausea/vomiting, Stomach pain, Flatulence, Bradycardia • Contraindications: Hypersensitivity, hyperphosphatemia, severe renal impairment, hyperkalemia
• 7.
  Citric acid/glucono-delta lactone/magnesiumcarbonate (renacidin) • Renacidin is sterile irrigation solution generally used to dissolve renal calculi composed of apatite (a calcium carbonate-phosphate compound) or struvite (magnesium ammonium phosphates). • Indication: Renal calculi, bladder calculi, renal catheter incrustation • Usually 30ml solution is used at a time and irrigation is done for 4-6 times a day. • Adverse effect : Flank pain, fever, UTI, back pain • Contraindications: hypersensitivity, UTI, sepsis
• 8.
  Urinary alkalizer • Theseare compounds that decreases acidity of urine (that means increases in pH of urine) • These are commonly used for symptomatic relief in UTIs. • Commonly used urinary alkalizer : • Sodium bicarbonate • Potassium citrate • Sodium citrate • Disodium hydrogen citrate
• 9.
  Sodium citrate • Sodiumcitrate is the sodium salt of citric acid. • It work by neutralizing excess acid in blood and urine. Indication: Metabolic acidosis As Urinary alkalizers for prevention of nephrolithiasis Dose:10-30 ml diluted in glass of water at HS or PRN Adverse effect : Diarrhea, Nausea, Metabolic alkalosis, Vomiting, Stomach pain, Fluid retention. Contraindication: hypersensitivity, severe renal impairment. Not recommended in pregnancy Drug Interaction: sodium citrate might decrease absorption azithromycin, allopurinol, atenolol, alendronate.
• 10.
  Disodium hydrogen citrate Itis sodium acid salt of citric acid and sodium citrate. Indication: Metabolic acidosis As Urinary alkalizers for prevention of nephrolithiasis and in UTI Dosage: 10-30 ml diluted in glass of water at HS or PRN Adr: Diarrhea, Nausea, Metabolic alkalosis, Vomiting, Stomach pain, Fluid retention. CI: hypersensitivity, severe renal impairment. Not recommended in pregnancy Interaction: sodium citrate might decrease absorption azithromycin, allopurinol, atenolol, alendronate.
• 11.
  Sodium bicarbonate • Itis also commonly use urinary alkalizer. • It have wide range of application. • Indication: • Metabolic acidosis: 2-5 mEq/kg IV infusion over 4-8 h • Hyperkalemia: 50 mEq IV over 5 minutes • Urinary alkalizer • Dosage: inj 4%, 7.5%, Tab: 325 mg, 650mg • Adr: Aggravated CHF, Cerebral hemorrhage, Edema, Hypernatremia, Hypocalcemia, Hypokalemia • Contraindication: hypersensitivity, CHF
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  Thank you