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A parallel treatment consisted of furosemide for fluid overload and acetazolamide for urine alkalinization.

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Discussion Methotrexate is an antimetabolite that interferes with the metabolism of folic acid. After entering cells, methotrexate binds to dihydrofolate reductase DHFR with an affinity that is 1000-fold greater than that of folate, and thus competitively inhibits the conversion of dihydrofolate to tetrahydrofolate, which is essential for the biosynthesis of thymidine and purines for DNA synthesis.

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The blockade of tetrahydrofolate synthesis by methotrexate leads to an inability of cells to divide and produce proteins. This precipitation occurs when the pH is lower than 5.

Adequate hydration and urine alkalinization are therefore crucial to avoiding renal toxicity due to highly soluble metabolites.


Many antineoplastics and antibiotics as well as low molecular weight heparin LMWH are relatively or absolutely contraindicated in the presence of renal toxicity, so compromised renal function further complicates patient care.

Before we propose a strategy for the management of HD-MTX in the day care setting, it is worth discussing the acid-base balance with the aid of a Davenport diagram.

The acid-base balance is largely maintained by the kidney and lungs. The principal acid involved in this balance is carbon dioxide CO 2, which is a weak volatile acid.


There are also fixed acids such as those liberated during metabolism e. The principal buffers are open system buffers such as bicarbonate HCO 3 and closed system buffers such as phosphate and hemoglobin.

Only HD MTX was not prolonged for our patient, he was not an after candidate for day care management.
Zithromax is used to treat many active types of infections caused by bacteria, such.

Respiratory acidosis and alkalosis are compensated for by metabolic alkalosis and acidosis, respectively, and vice versa, with the exception that metabolic alkalosis cannot be compensated for by respiratory acidosis to ensure that hypopnea-induced tissue hypoxia does not occur.

Most of our patients are anemic and thus have reduced hemoglobin closed system buffer levels, which could compromise the acid-base balance.

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    Serial blood and urine samples were collected, and urine pH was evaluated. Plasma electrolytes and pH were also measured for safety purposes. No adverse effects or abnormal blood results were documented during the 24-h follow-up.

    Sodium bicarbonate NaHCO 3 12. NaHCO 3 induces a transient increase in plasma osmolality by increasing the bicarbonate level.

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