A client is seen in the emergency department for an overdose of diazepam (Valium), a weakly basic drug. In order to enhance excretion of the drug, what does the nurse anticipate that the client will receive?
1. High volumes of intravenous normal saline solution (NSS), a weakly basic solution
2. Large doses of a proton pump inhibitor, in an acidic solution
3. An intravenous solution containing sodium bicarbonate, which promotes alkaline urine
4. An intravenous solution with ammonium chloride, which acidifies filtrate
Correct Answer: 4
Rationale 1: Although high volumes of NSS will increase the glomerular filtration and promote diuresis, it will not promote the elimination of diazepam.
Rationale 2: A proton pump inhibitor would not help to promote elimination of the diazepam.
Rationale 3: Sodium bicarbonate is given to promote alkaline urine, but does not promote the elimination of diazepam.
Rationale 4: Ammonium chloride will provide acidic urine, in which the diazepam will be eliminated more quickly.
Global Rationale: Ammonium chloride will provide acidic urine, in which the diazepam will be eliminated more quickly. Although high volumes of NSS will increase the glomerular filtration and promote diuresis, it will not promote the elimination of diazepam. A proton pump inhibitor would not help to promote elimination of the diazepam. Sodium bicarbonate is given to promote alkaline urine, but does not promote the elimination of diazepam.
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