A simple modified bicarbonate regimen for urine alkalinization in moderate pediatric salicylate poisoning in the emergency department.

A 4-year-old Indian girl was seen in our emergency department for unintentional ingestion of topical medication oil with subsequent salicylate poisoning. Serum levels were 52 mg/dL at 12 hours after ingestion.She was started on urine alkalization therapy to enhance salicylate elimination. This was achieved by a bicarbonate bolus of 1 mEq/kg for an hour and a continuous bicarbonate-potassium-dextrose combination infusion. The infusion regimen was modified from adult recommendations to tailor for pediatric physiological requirements in a young child. This consisted of a combination solution of dextrose 5%-sodium bicarbonate-potassium chloride with similar sodium content as half-strength (0.45%) saline and supplemental potassium, which is crucial for effective urine alkalinization. The combination fluid was administered at a rate 1.5 times her maintenance fluid requirement to achieve a urine output of 1.5 to 2 mL/kg per hour and a urine pH of 7.5 to 8.5. This regimen was well tolerated with good outcome.Many pediatricians and toxicologists achieve urine alkalinization by giving multiple bicarbonate boluses and have separate hydration fluids with dextrose and supplemental potassium. These regimens may involve complex calculations and multiple infusions that may lead to increased risk of calculation and medication errors especially in the busy emergency department setting. This case report highlights the use of a simple modified urine alkalinization regimen for moderate salicylate poisoning in a young child in the emergency department.