Sodium Bicarbonate Shortage

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					                         Sodium Bicarbonate Shortage
    Sodium Bicarbonate is currently at a national critical low shortage. In order to properly
    distribute our supply, non-emergent uses of sodium bicarbonate should be minimized.
    Other buffering agents are available, as listed below, for use in specific situations. Only
    emergent use or situations where no suitable alternative is available should sodium
    bicarbonate should continue to be used. Please contact the pharmacy for any questions.

                  Salt                      mEq HCO3 / gm Salt              mg salt / mEq HCO3
           Sodium Bicarbonate                     11.9                               84
             Sodium Acetate                        7.3                              136
             Sodium Lactate                        8.9                              112

Available Supplies:

Sodium Bicarbonate (2.5mEq/5mL) 4.2% 5mL vials

Sodium Lactate 5 mEq/mL 10 mL vials

Sodium Acetate 4 mEq/mL 50 mL vials

      Sodium Lactate should not be used in patients with congenital heart disease and respiratory
       alkalemia. Patients with severe liver impairment and lactic acidosis should also not receive
       lactate as the conversion to bicarbonate is impaired. Measurements of serum lactate to gauge
       severity of various disease states will also not be reliable during administration of sodium
       lactate. The metabolism of lactate to bicarbonate is a 1 -2 hour process and would not be the
       best alternative where immediate correction of acidosis is needed.

      Sodium Acetate is metabolized outside the liver and would be a safe alternative to sodium
       lactate in most situations. The conversion is rapid and allows immediate release of bicarbonate.

      Both Lactate and Acetate are converted on a 1:1 mEq basis to bicarbonate. Dosing should be
       based off of mEq, not amps, grams, or milligrams. Dosing is heavily dependent on a wide range
       of indications. Please consult the pharmacy for dosing questions.

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