Final answer:
To increase the rate of urinary excretion of tolbutamide, administration of sodium bicarbonate (NaHCO3) is most appropriate because it alkalinizes the urine and reduces the reabsorption of weak acids like tolbutamide, leading to higher excretion rates.
Step-by-step explanation:
The patient who has ingested a large quantity of tolbutamide, a sulfonylurea used in the treatment of type 2 diabetes, would most likely benefit from sodium bicarbonate (NaHCO3) for increasing the rate of urinary excretion of the drug. NaHCO3 alkalinizes the urine, which promotes the renal excretion of weak acids by decreasing their reabsorption. Tolbutamide is a weak acid, so when the urine is alkaline, less tolbutamide is reabsorbed, and more is excreted. Drugs such as loop diuretics, which inhibit the reabsorption of sodium (Na+) and chloride (Cl-) ions in the ascending limb of the loop of Henle, can also increase urination as a side effect by preventing water reabsorption and consequently increasing urine output. This process is also influenced by osmotic diuretics like mannitol and medical conditions such as poorly controlled diabetes mellitus, which can lead to diuresis through the presence of glucose in the urine acting as an osmotic agent.