Sodium Bicarbonate Inj Shortage 10.1.18

To:      Physician, Nursing and Pharmacy Staff
From: Maryna Shayuk, MD, Chair, Pharmacy and Therapeutics
            Alan Mader, PharmD, Pharmacy Clinical Coordinator
Date:   9/26/2018
Re:        Sodium Bicarbonate Injection Shortage

Situation

Sodium Bicarbonate 8.4% Injection 50 mL is currently on shortage. There are different projections on how long this shortage will last, with some continuing until 2019. Sodium Bicarbonate is used for CODE BLUE situations and is available in Crash Carts. It is also used for Open Heart Surgery and for Toxicologic Emergencies.

Background

The supply of Sodium Bicarbonate 8.4% Injection has not been stable for some time.

Assessment

With uncertain supply, steps to maintain availability for Crash Cart Supply and for Open Heart Surgery need to be implemented.

Recommendation

Pharmacy will sequester supply to maintain stock for Crash Carts and for the surgical Open Heart room. When orders are received for sodium bicarbonate infusion, pharmacy will directly provide recommendation with the ordering physician to use sodium acetate injection. Information on the use of sodium acetate infusion is shown below:

Toxicologic Emergencies – Use Sodium Acetate 2 mEq/mL
a. Bolus (if required) – 1 mEq/kg/D5W 500 mL infused over 20 minutes (consistent
with information presented by ASHP). 150 mEq maximum to avoid osmolarity issues.
For patients over 100 Kg, infuse over 30 minutes.
b. Maintenance: Na Acetate 150 mEq/D5W 1000mL infused at 200 mL/hr for adult
patients. 3 bag limit. The same rate would be used for urine alkalinization.

We are anticipating that the shortage will end before supply becomes depleted. If that is not the case, sodium acetate may also be used in Code situations as follows:

Crash Cart/Code situation – Requires dilution/infusion. 50 mEq Sodium Acetate added to 100 mL D5W (125mL TV) administered over 10 minutes