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
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.