ACIDIFIERS
DEFINITION
Acidifiers are the drugs or agents, which are
used to treat acid-base imbalance in the body or
for the treatment of metabolic alkalosis.
CLASSIFICATION
1. Ammonium chloride
2. Ascorbic acid
3. Calcium chloride
4. Phenezopyridine
1. AMMONIUM CHLORIDE
Ammonium chloride is used as a systemic and
urinary acidifier to treat metabolic alkalosis, to
correct chloride depletion and to assist in urinary
excretion of certain basic drugs.
Mechanism of Action
Ammonium chloride increases acidity by
increasing the amount of hydrogen ion
concentrations.
Ammonium ion is converted to urea in the liver
and chloride ion replaces bicarbonate ions
DOSES
1. Expectorants – adults : 200-400mg every
4hourly
2. Children : 50-75 mg/kg in divided doses
3. Urinary acidification – 3-12 g per day in
divided doses at 4-6 hours interval.
INDICATIONS
1. Metabolic alkalosis
2. Hypochloremia
3. Adrenal gland hyperactivity
CONTRAINDICATIONS
4. Renal disease
5. Hepatic disorders
6. Pulmonary diseases
SIDE EFFECTS
1. Metabolic acidosis
2. Headache
3. Hyperglycemia
4. Hypokalemia
5. Too rapid IV administration can result in
arrhythmias, convulsions and coma.
NURSING CONSIDERATIONS
1. Assess the patient regularly for arrythmia and
shortness of breath.
2. Administer cautiously in patients with cardiac
diseases.
3. Avoid administration of milk or any other alkaline
food articles.
4. Instruct patient to take the drug with meals to avoid
any GI disturbances.
2. ASCORBIC ACID
Vitamin-C or Ascorbic acid is an essential
dietary substance that plays a major role in many
metabolic reactions as the formation and
maintenance of collagen and intracellular ground
substances.
Mechanism of Action
Ascorbic acid acts as an acidifier, which helps to
neutralize the alkali excess, thus helps to reduce
the PH toward its normal values.
DOSE
Oral
Adults- 50-100 mg/day.
Children- 30-40 mg /day.
Urinary acidification- 4-12 g/day in divided doses (4-
6 hourly)
IM,SC,IV
up to 2g/day as needed for severe deficiency
states
Maintenance dose is 100-250 mg once or twice
a day.
SIDE EFFECTS
1. Diarrhea
2. Renal stones
3. Dizziness
4. Hemochromatosis
NURSING RESPONSIBILITIES
1. Use cautiously in patients with glucose 6-
phosphate dehydrogenase deficiency,
hyperuricemia, or renal impairment and
pregnant women.
2. Injecting slow IV avoid dizziness or fainting.
ALKALINIZERS
DEFINITION
Alkalinizers are the agents or drugs, which are
used to neutralize the the PH, which has been
decreased due to certain causes like metabolic
acidosis.
Example: Sodium bicarbonate, Potassium citrate,
Acetazolamide
1. SODIUM BICARBONATE
Sodium bicarbonate , also known as baking soda,
is used to relieve heartburn, sour stomach, or acid
indigestion by neutralizing excess stomach acid.
When used for this purpose, it is said to belong to
the group of medicines called antacids.
DOSE
Oral -100-400 mg/kg
per day for 3-7 days
SODIUM BICARBONATE
Mechanism of action
The main therapeutic effect of intravenous sodium
bicarbonate administration is increasing plasma
bicarbonate levels, which buffer excess hydrogen ion
(H ) concentration, raising serum pH to combat clinical
+
manifestations of acidosis.
INDICTIONS
1. Treatment of GI symptoms associated with
hyperacidity. eg : heart burn, indigestion
2. Treatment of hyperacidity associated with
Gastritis, Peptic ulcer etc.
3. Metabolic acidosis
CONTRAINDICATIONS
1. Cardiac diseases
2. Renal patients
3. Hypertension
4. Hypernatremia
5. Pregnancy
6. Lactation
7. Children under 6 years of age
ADVERSE REACTIONS
1. Metabolic alkalosis.
2. Headache.
3. Muscle pain and twitching.
4. Nausea or vomiting.
5. Bradypnea.
6. Nervousness or restlessness.
7. Unpleasant taste.
8. Increased frequency of urination.
NURSING RESPONSIBILITIES
1. Administer alkalinizers in liquid form than the
other methods for efficacy of the drug action.
2. Drug need to take on empty stomach for better
action.
3. Instruct patient to chew tablet before
swallowing followed by enough water.
2. POTASSIUM CITRATE
Potassium citrate is used
to control uric acid and
cystine kidney stones.
INDICATIONS
Effective in reducing pain and frequency of
micturation when these are caused by highly
acidic urine.
Widely used to treat urinary calculi and
patients with cystinuria.
DOSE
Solution:
1. Adults : 2-3 tsps of solution mixed with
water or juice four times a day after meals.
2. Children : 1-3 tsps of solution mixed with
water or juice four times a day after meals
and bed time.
CONTRAINDICATIONS
1. Cardiac diseases
2. Hyperkalemia
3. Renal diseases
4. Severe diarrhea
5. Metabolic alkalosis
SIDE EFFECTS
1. Muscle cramps
2. Dizziness
3. Irregular heartbeat
4. Mood changes (such as confusion, restlessness)
5. Tingling of the hands/feet,
6. Unusually cold skin.
NURSING RESPONSIBILITIES
1. Avoid administration of milk or any other
alkaline food articles.
2. Avoid the drug for cardiac patients.
3. Drink plenty of fluids (atleast 2litres of water
per day).
4. Closely monitor for laboratory values.
2. ACETAZOLAMIDE
Acetazolamide is a
carbonic anhydrase
inhibitor.
The drug has mild diuretic
also.
MECHANISM OF ACTION
In the kidney, acetazolamide reduces the
availability of hydrogen ions for excretion into
the urine at the proximal tubule and reduces
bicarbonate reabsorption by up to 80%.
This reduction results in production of alkaline
urine, owing to increased bicarbonate losses, and
promotes a normal anion gap metabolic acidosis.
INDICATIONS
1. Glaucoma
2. To alkaline urine
3. Epilepsy
4. Mountain sickness
5. Metabolic alkalosis
DOSE: 8-30 mg/kg/day in divided doses;
CONTRAINDICATIONS
1. Metabolic acidosis
2. Hypersensitivity to the drug
3. Pregnancy
4. Lactation
SIDE EFFECTS
1. Polyurea
2. Hematuria
3. Drowsiness
4. Hepatic dysfunction
5. Confusion and disorientation
6. Urticaria
NURSING RESPONSIBILITIES
1. Assess for the mentioned cautions and contraindications (e.g.
drug allergies, hepatic dysfunction etc.) to prevent any
complications.
2. Observe signs of metabolic acidosis.
3. Blood glucose level may become temporarily elevated in
patients with diabetes (it alters the effect of anti-diabetic drug).
4. Monitor intake output strictly.
5. Instruct patient to avoid driving while on drug therapy.
