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J. Med. Toxicol. (2013) 9:250254 DOI 10.1007/s13181-013-0304-0
REVIEW ARTICLE
Sodium Acetate as a Replacement for Sodium Bicarbonate in Medical Toxicology: a Review
Mark J. Neavyn & Edward W. Boyer & Steven B. Bird &
Kavita M. Babu
Published online: 30 April 2013# American College of Medical Toxicology 2013
Abstract Sodium bicarbonate is central to the treatment of many poisonings. When it was placed on the FDA drug shortage list in 2012, alternative treatment strategies to specific poisonings were considered. Many hospital pharmacies, poison centers, and medical toxicologists proposed sodium acetate as an adequate alternative, despite a paucity of data to support its use in medical toxicology. The intention of this review is to educate the clinician on the use of sodium acetate and to advise them on the potential adverse events when given in excess. We conducted a literature search focused on the pharmacology of sodium acetate, its use as a buffer in pathologic acidemia and dialysis baths, and potential adverse events associated with excess sodium acetate infusion. It appears safe to replace sodium bicarbonate infusion with sodium acetate on an equimolar basis. The metabolism of acetate, however, is more complex than bicarbonate. Future prospective studies will be needed to confirm the efficacy of sodium acetate in the treatment of the poisoned patient.
Keywords Sodium acetate . Sodium bicarbonate . Antidote . Drug shortage
Introduction
A shortage of sodium bicarbonate reported by the FDA in March 2012 arose from a demand increase in the drug [1]. The shortage recovered for the majority of sodium bicarbonate products during the first and second quarter of 2013,
but drug shortages have increasingly plagued the medical community over the last several years, and future product availability remains unpredictable for sodium bicarbonate. Shortages of drugs such as diazepam, metoclopramide, ondansetron, phenytoin, and etomidate that have a great impact on emergency patient care are increasingly prevalent [1]. Effective alternatives exist when most common medications are in short supply. Sodium bicarbonate is unique as a therapeutic agent; even though it is a vital intervention in the treatment of several poisonings, it has no clearly accepted alternative in clinical use. Primary outcomes in sodium bicarbonate therapy include serum alkalinization, urine alkalinization, and sodium ion loading. Recommendations for a replacement antidote when sodium...