{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,4]],"date-time":"2026-05-04T22:40:48Z","timestamp":1777934448346,"version":"3.51.4"},"reference-count":20,"publisher":"SAGE Publications","issue":"1","license":[{"start":{"date-parts":[[2020,4,21]],"date-time":"2020-04-21T00:00:00Z","timestamp":1587427200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["J Oncol Pharm Pract"],"published-print":{"date-parts":[[2021,1]]},"abstract":"\n Introduction<\/jats:title>\n \n Methotrexate (MTX) is a cytotoxic antimetabolite. Intravenous (IV) hydration and urine alkalinization with sodium bicarbonate (NaHCO\n 3<\/jats:sub>\n ) can mitigate nephrotoxicity associated with high-dose MTX (HDMTX, doses \u2265500\u2009mg\/m\n 2<\/jats:sup>\n ). A shortage of IV NaHCO\n 3<\/jats:sub>\n in 2017 prompted Alberta Children\u2019s Hospital (ACH) and Stollery Children\u2019s Hospital (SCH) to adopt an alternative protocol including oral NaHCO\n 3<\/jats:sub>\n and IV hydration with Lactated Ringer\u2019s (LR).\n <\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n \n A retrospective chart review was conducted for ACH and SCH inpatients who received HDMTX between January and December 2017. The primary outcome was the proportion of cycles with delayed HDMTX clearance within the IV and oral cohorts. Secondary outcomes include NaHCO\n 3<\/jats:sub>\n administered until clearance, NaHCO\n 3<\/jats:sub>\n required to reach pH \u22657, time to reach pH \u22657, incidence of pH <7, time to clearance, and time to discharge. Adverse effects associated with delayed clearance or NaHCO\n 3<\/jats:sub>\n administration were also reported.\n <\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n 112 MTX cycles were included, 50 and 62 from the IV and oral cohorts, respectively. Clearance delays beyond protocol expectations occurred in 10 cycles (8.9%), 5 from each cohort ( p\u2009=\u20090.72). Differences between cohorts were not statistically significant, except the amounts of NaHCO\n 3<\/jats:sub>\n required until clearance (383 vs. 277\u2009mmol\/m\n 2<\/jats:sup>\n , p\u2009=\u20090.005) and to reach pH \u22657 (52 vs. 40\u2009mmol\/m\n 2<\/jats:sup>\n , p\u2009=\u20090.004) were lower in the oral cohort. Incidences of adverse effects were not different.\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n \n Oral NaHCO\n 3<\/jats:sub>\n with LR is a feasible alternative for urine alkalinization. The total dose of NaHCO\n 3<\/jats:sub>\n utilized was lower in the oral cohort, with no additional delays in clearance.\n <\/jats:p>\n <\/jats:sec>","DOI":"10.1177\/1078155220915769","type":"journal-article","created":{"date-parts":[[2020,4,22]],"date-time":"2020-04-22T01:51:40Z","timestamp":1587520300000},"page":"119-127","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":6,"title":["Oral sodium bicarbonate protocol for high-dose methotrexate urine alkalinization: A pediatric experience"],"prefix":"10.1177","volume":"27","author":[{"given":"Mark","family":"Diachinsky","sequence":"first","affiliation":[{"name":"Pharmacy Services, Stollery Children\u2019s Hospital, Alberta Health Services, Edmonton, AB, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2097-4836","authenticated-orcid":false,"given":"Tracey","family":"Tran","sequence":"additional","affiliation":[{"name":"Pharmacy Student, Faculty of Pharmacy and Pharmaceutical Sciences, University of Alberta, Edmonton, AB, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jennifer","family":"Jupp","sequence":"additional","affiliation":[{"name":"Pharmacy Services, Alberta Children\u2019s Hospital, Alberta Health Services, Calgary, AB, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8280-9687","authenticated-orcid":false,"given":"Krista","family":"McKinnon","sequence":"additional","affiliation":[{"name":"Pharmacy Services, Alberta Children\u2019s Hospital, Alberta Health Services, Calgary, AB, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"179","published-online":{"date-parts":[[2020,4,21]]},"reference":[{"key":"bibr1-1078155220915769","unstructured":"Pfizer. Methotrexate injection USP monograph, https:\/\/www.pfizer.ca\/sites\/g\/files\/g10050796\/f\/201710\/Methotrexate_Injection_PM_E_207725_13Oct2017.pdf (2017, accessed 20 June 2019)."},{"key":"bibr2-1078155220915769","doi-asserted-by":"publisher","DOI":"10.1634\/theoncologist.2015-0164"},{"key":"bibr3-1078155220915769","doi-asserted-by":"publisher","DOI":"10.1002\/phar.1935"},{"key":"bibr4-1078155220915769","unstructured":"Children\u2019s Oncology Group. COG protocol AALL0631: a phase III study of risk directed therapy for infants with acute lymphoblastic leukemia (ALL): randomization of highest risk infants to intensive chemotherapy +\/\u2013 FLT3 inhibition (CEP-701, Lestaurtinib; IND#76431, NSC#617807), https:\/\/www.cogmembers.org\/Site\/Prot\/ProtInfo.aspx?ProtocolNum=1367 (2013, accessed 24 April 2019)."},{"key":"bibr5-1078155220915769","unstructured":"Children\u2019s Oncology Group. COG protocol AALL1131: a phase III randomized trial for newly diagnosed high risk B-lymphoblastic leukemia (B-ALL) including a stratum evaluating dasatinib in patients with Ph-like tyrosine kinase inhibitor (TKI) sensitive mutations, https:\/\/cogmembers.org\/Site\/Prot\/ProtInfo.aspx?ProtocolNum=1587 (2012, accessed 12 January 2018)."},{"key":"bibr6-1078155220915769","unstructured":"Children\u2019s Oncology Group. COG protocol AALL1231: a phase III randomized trial investigating bortezomib (NSC# 681239; IND# 58443) on a modified augmented BFM (ABFM) backbone in newly diagnosed T-lymphoblastic leukemia (T-ALL) and T-lymphoblastic lymphoma (T-LLy), https:\/\/www.cogmembers.org\/Site\/Prot\/ProtInfo.aspx?ProtocolNum=1740 (2017, accessed 24 April 2019)."},{"key":"bibr7-1078155220915769","unstructured":"Children\u2019s Oncology Group. COG protocol AALL1331: risk-stratified randomized phase III testing of blinatumomab (IND#117467, NSC#765986) in first relapse of childhood B-lymphoblastic leukemia (B-ALL), https:\/\/www.cogmembers.org\/Site\/Prot\/ProtInfo.aspx?ProtocolNum=1780 (2018, accessed 24 April 2019)."},{"key":"bibr8-1078155220915769","unstructured":"Children\u2019s Oncology Group. COG protocol AOST0121: a groupwide phase II study of trastuzumab (herceptin) in metastatic osteosarcoma patients with tumors that overexpress HER2, https:\/\/www.cogmembers.org\/Site\/Prot\/ProtInfo.aspx?ProtocolNum=986 (2005, accessed 24 April 2019)."},{"key":"bibr9-1078155220915769","unstructured":"Children\u2019s Oncology Group. COG protocol AOST0331: a randomized trial of the European and American Osteosarcoma Study Group to optimize treatment strategies for resectable osteosarcoma based on histological response to pre-operative chemotherapy, https:\/\/cogmembers.org\/Site\/Prot\/ProtInfo.aspx?ProtocolNum=1149 (2011, accessed 12 January 2018)."},{"key":"bibr10-1078155220915769","unstructured":"Children\u2019s Oncology Group. COG protocol ANHL1131: intergroup trial for children or adolescents with B-cell non-Hodgkin lymphoma NHL or mature B-cell leukemia B-AL: evaluation of rituximab (IND #10385) efficacy and safety in high risk patients, https:\/\/cogmembers.org\/Site\/Prot\/ProtInfo.aspx?ProtocolNum=1610 (2016, accessed 12 January 2018)."},{"key":"bibr11-1078155220915769","doi-asserted-by":"publisher","DOI":"10.2146\/ajhp150407"},{"key":"bibr12-1078155220915769","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajem.2013.08.031"},{"key":"bibr13-1078155220915769","doi-asserted-by":"publisher","DOI":"10.1177\/1078155215610914"},{"key":"bibr14-1078155220915769","doi-asserted-by":"publisher","DOI":"10.1007\/BF00689708"},{"key":"bibr15-1078155220915769","doi-asserted-by":"publisher","DOI":"10.1177\/1060028017740598"},{"key":"bibr16-1078155220915769","doi-asserted-by":"publisher","DOI":"10.1177\/1078155218821406"},{"key":"bibr17-1078155220915769","first-page":"2184","volume":"40","author":"Bode U","year":"1980","journal-title":"Cancer Res"},{"key":"bibr18-1078155220915769","doi-asserted-by":"publisher","DOI":"10.1097\/MPH.0000000000001348"},{"key":"bibr19-1078155220915769","unstructured":"Johns Hopkins sodium bicarbonate shortage quick reference document: changes in urine alkalinization for IV high-dose methoxtrexate (\u22655g\/m\n 2\n ) and changes in urine alkalinization for IV intermediate\/moderate-dose methotrexate (>1\u2009g\/m\n 2\n and <5\u2009g\/m\n 2\n ). 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