Editing Diuresis (section)

===Diuretics===
{{Main|Diuretic}}

Most diuretic drugs are either [[Acid strength#Weak acids|weak acids]] or [[weak base]]s. When urine is made [[alkali]]ne, elimination of acidic drugs in the urine is increased. The converse applies for alkaline drugs. This method is only of therapeutic significance where the drug is excreted in active form in urine and where the [[pH]] of urine can be adjusted to levels above or below the [[Acid dissociation constant|pK]] value of the active form of drug. For acidic drugs, urine pH should be above the [[Acid dissociation constant|pK]] value of that drug, and converse for the basic drugs. It is because the [[ionization]] of acidic drug is increased in alkaline urine and ionized drugs cannot easily cross a [[Cell membrane|plasma membrane]] so cannot re-enter blood from [[Nephron#Renal tubule|kidney tubules]]. This method is ineffective for drugs that are strongly protein bound (e.g., [[tricyclic antidepressant]]s) or which have a large apparent [[volume of distribution]] (e.g. [[paracetamol]], tricyclic antidepressants).<ref>{{Cite web |title=Overdose |url=http://www.aic.cuhk.edu.hk/web8/poisoning.htm |url-status=dead |archive-url=https://web.archive.org/web/20201026160651/https://www.aic.cuhk.edu.hk/web8/poisoning.htm |archive-date=2020-10-26 |access-date=2015-05-11 |publisher=Aic.cuhk.edu.hk}}</ref>

For '''forced alkaline diuresis''',<!--per MOS:BOLD due to redirect--> [[sodium bicarbonate]] is added to the infusion fluid to make blood and, in turn, urine alkaline. [[Potassium]] replacement becomes of utmost importance in this setting because potassium is usually lost in urine. If blood levels of potassium are depleted below normal levels, then [[hypokalemia]] occurs, which promotes bicarbonate ion retention and prevents bicarbonate excretion, thus interfering with alkalinization of the urine. Forced alkaline diuresis has been used to increase the excretion of acidic drugs like [[Salicylic acid|salicylates]] and [[Phenobarbital|phenobarbitone]], and is recommended for [[rhabdomyolysis]].{{medical citation needed|date=May 2015}}

For '''forced acid diuresis''',<!--per MOS:BOLD due to redirect--> [[Vitamin C|ascorbic acid]] ([[vitamin C]]) is sometimes used. [[Ammonium chloride]] has also been used for forced acid diuresis, but it is a [[Toxicity|toxic]] compound.<ref>{{Cite journal |last=Györke |first=Z. S. |last2=Sulyok |first2=E. |last3=Guignard |first3=J. P. |date=1991 |title=Ammonium chloride metabolic acidosis and the activity of renin-angiotensin-aldosterone system in children |url=https://pubmed.ncbi.nlm.nih.gov/1954957/ |journal=European Journal of Pediatrics |publisher=PubMed |volume=150 |issue=8 |pages=547–549 |doi=10.1007/BF02072203 |pmid=1954957 |s2cid=12944342 |access-date=2024-01-28}}</ref> Usually, however, this technique only produces a slight increase in the [[Clearance (pharmacology)|renal clearance]] of the drug. Forced acid diuresis is rarely done in practice,<ref>{{Cite web |title=Toxbook Singapore |url=https://www.scribd.com/doc/60001926/Toxbook-Singapore |access-date=2015-05-11 |publisher=Scribd.com}}</ref> but can be used to enhance the elimination of [[cocaine]], [[amphetamine]], [[quinine]], [[quinidine]], [[atropine]] and [[strychnine]] when poisoning by these drugs has occurred.