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Variation in Quinidine Excretion with Changing Urine pH.

Robert F. Knouss, B.S.; Robert E. Gebhardt, B.A.; Per T. Thyrum, Ph.D.; Robert J. Luchi, M.D., F.A.C.P.; and James J. Morris, M.D.
Ann Intern Med. 1968;68(5):1157. doi:10.7326/0003-4819-68-5-1157_2
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Quinidine toxicity may develop unexpectedly when the urine becomes alkaline in disease or during alkalinizing therapy. Urinary excretion of quinine, the optical isomer of quinidine, is known to be retarded by urine alkalinization. These observations prompted study of renal excretion of quinidine as a function of urine pH. Four subjects were given 0.2 g of quinidine sulfate orally every 6 hr. After a 5-day "loading period" urine quinidine and pH were determined for each voiding during 4 days of aciduria and 4 days of alkaluria (acetazolamide and sodium bicarbonate). The results indicated that urine excretion of quinidine varied inversely with


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