Prospective study on oral alkalization in patients receiving high dose methotrexate.

e18804Background: High-dose methotrexate (MTX), used in protocols for treatment and prevention of central nervous system disease in multiple types of cancer, requires intravenous (IV) hydration and monitoring of urine output and pH parameters. Traditionally IV sodium bicarbonate (bicarb) is used, but it has been on shortage. As there are limited data on oral (PO) alternatives, this prospective study evaluated the use of PO bicarb and acetazolamide to alkalinize urine. Methods: A multidisciplinary team at the University of Virginia was formed. Retrospective chart review of 34 patient encounters from 5/2016-4/2017 were reviewed to establish our baseline cohort of IV bicarb use. We studied patient encounters from 5/2017-10/2017 with the intervention of using PO bicarb in combination with acetazolamide for urine alkalization. The primary outcome was time to MTX administration and secondary outcomes included length of stay (LOS), incidence of acute kidney injury (AKI), MTX clearance, and bicarb utilization. A ...