Oral sodium bicarbonate protocol for high-dose methotrexate urine alkalinization: A pediatric experience
Bibliographic record
Abstract
Introduction Methotrexate (MTX) is a cytotoxic antimetabolite. Intravenous (IV) hydration and urine alkalinization with sodium bicarbonate (NaHCO 3 ) can mitigate nephrotoxicity associated with high-dose MTX (HDMTX, doses ≥500 mg/m 2 ). A shortage of IV NaHCO 3 in 2017 prompted Alberta Children’s Hospital (ACH) and Stollery Children’s Hospital (SCH) to adopt an alternative protocol including oral NaHCO 3 and IV hydration with Lactated Ringer’s (LR). Methods 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 3 administered until clearance, NaHCO 3 required to reach pH ≥7, time to reach pH ≥7, incidence of pH <7, time to clearance, and time to discharge. Adverse effects associated with delayed clearance or NaHCO 3 administration were also reported. Results 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 = 0.72). Differences between cohorts were not statistically significant, except the amounts of NaHCO 3 required until clearance (383 vs. 277 mmol/m 2 , p = 0.005) and to reach pH ≥7 (52 vs. 40 mmol/m 2 , p = 0.004) were lower in the oral cohort. Incidences of adverse effects were not different. Conclusions Oral NaHCO 3 with LR is a feasible alternative for urine alkalinization. The total dose of NaHCO 3 utilized was lower in the oral cohort, with no additional delays in clearance.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.003 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.001 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".