“There is no discrete antidote available for 2,4-D dimethylamine intoxication. Chlorophenoxy is a weak acid (pKa 2.6 for 2,4-D) that is excreted in the urine in the same form. Intravenous sodium bicarbonate has its mechanism of action to act by increasing urine pH. Renal excretion is better in alkaline urine conditions (63 ml/min at pH 8.3) than in acidotic conditions (0.14 ml/min at pH 5.1) of urine” [7]. “For each unit increase in urine pH, the clearance of 2,4-D by the kidney is estimated to increase nearly five-fold” [3]. “Therefore its necessary to note that the administration of sodium bicarbonate with a target urine flow of 4–6 ml/minute increases the excretion of 2, 4-D dimethylamine. In this scenario, urine pH after alkaline diuresis was not assessed, so the renal clearance and half time of 2,4-D in this patient could not be stated. Hypokalaemia may occur during alkaline diuresis, according to the literature, hence sodium bicarbonate should be followed by potassium injection”
Author(s) Details:
Manjiri Naik,
Department of Medicine, MGM Medical College and Hospital, Aurangabad, India.
Shamisha Khade,
Department of Medicine, MGM Medical College and Hospital, Aurangabad, India.
