Sodium Acetate as a Replacement for Sodium Bicarbonate in Medical Toxicology: a Review

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.

Remarkable Improvement in Water Oxidation Catalysis by Moderate Heat Treatment of a Crystalline Silver‐Based Thin Film Developed In‐Situ From Silver‐ions in Acetate Solution

“…[48] Treatment of silver ions in a sodium bicarbonate gives less soluble Ag 2 CO 3 than AgOAc, in-situ generated from sodium acetate, and as sodium bicarbonate is central of treatment of many poisonings, thus it appears to be suitable as well as safe to replace sodium bicarbonate infusion with sodium acetate in order to implement an environmentally benign, safe and new preparation method. [59] To date, metal oxides based on Mn, Fe and Co, in situ generated in a sodium acetate electrolyte, have shown moderate to high activites towards water oxidation. [12,25,29,31] Moreover, it is worth mentioning that improvement of catalytic activity of the as-deposited metal oxide films (Mn, Fe, Co, Ni and Cu) either by anodization in electrolyte solution [32,34,35] or by annealing at higher temperature [19,27,28,47] is reported frequently, though by simple technique like annealing at moderate temperature is very seldom reported.…”

Sodium Acetate Infusion for Serum and Urine Alkalinization

“…[2][3][4] Fortunately, sodium acetate appears to be an adequate alternative for serum alkalinization, urinary alkalinization, and sodium ion loading. 5 Neavyn et al 5 reviewed the literature supporting sodium acetate as a substitute antidote during a previous sodium bicarbonate shortage in 2012. Although sodium acetate will correct a metabolic acidosis, prospective studies in the treatment of tricyclic antidepressants poisoning or salicylism are lacking.…”

“…6 Our patient had prolonged hypotension requiring vasopressors, which is a potential adverse effect of sodium acetate. 5 Additionally, she developed hypokalemia, a common adverse effect of serum and urinary alkalinization with either sodium acetate or sodium bicarbonate. She also developed pneumonia and acute respiratory distress syndrome, requiring prolonged intubation and mechanical ventilation as a result.…”

Critical Drug Shortages: Implications for Emergency Medicine

“…The organization has drafted guidelines for the management of shortages and purchasing guidelines for pharmacies. 48,49 The ASHP website also provides therapeutic alternatives to drugs in current shortages when available. 47 In response to widespread drug shortages, many institutions have attempted to develop specific evidence-based protocols for substitutions when possible.…”

“…One recent example included the use of sodium acetate as a replacement for sodium bicarbonate as an antidote for specific poisonings. 49 Information from these various sources can be used by hospital-based pharmacy staff, ED administration, and providers, to mitigate the effects of shortages.…”