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04/25/17 RC -- Sodium Bicarbonate Inj Shortage

From: Richard Cramer
To: Pharmacists
Sent: Tuesday, April 25, 2017 3:50:07 PM
Subject: Sodium Bicarbonate Inj Shortage


Folks, there is a VERY SERIOUS national shortage of sodium bicarbonate inj., we are projected to run out of NaHCO3 Inj. in 2 - 3 weeks time period, this includes both vials and syringes.  Sodium acetate and sodium lactate injections are also out on shortage.     The time when a NaHCO# inj. resupply may be available is currently projected to be sometime the 2nd half of May. Physician members of the P and T Committee today STRONGLY ENCOURAGED pharmacists to conserve our limited injection supply for those areas where it is REALLY NEEDED.  Let MDs know about dire national shortage situation and need to conserve bicarb inj as much as possible.

Pharmacists should review profiles regularly throughout the day to screen for patients on bicarb drips - get with MDs prescribing bicarb drips, to evaluate whether it is really needed, or bicarb tablets could be given orally if patient taking other po meds/nutrition, or per tube if in place.  ALL THE MDs at the P and T Comm mtg today STRONGLY supported giving the oral tablets if possible in place of the drip, under these shortage conditions. 

From David's email last Thursday, The Society of Critical Care Medicine (SCCM) lists some strategies for dealing with bicarb inj. shortage.  They list bicarb as being QUESTIONABLE efficacy in the following situations:  prevention of contrast induced nephropathy (use of NaCl is recommended), urinary alkalinization to enhance drug elimination - exception: enhancing elimination of high dose methotrexate, rhabdomyolysis (use NaCl), hyperkalemia (use ONLY in severe metabolic acidosis), sepsis induced acidosis (ONLY IF pH is <7.15) and diabetic ketoacidosis.  If ordered in these situaitons, discuss discontinuation of the bicarb drip with the MD and recommend recommend alternative therapy if applicable.  See Sodium Bicarbonate section on FORMWEB, Adam has linked a document titled "Sodium Bicarbonate IV Alternative Therapy" from SCCM that contains these recommendations.   Also, patient may be able to take oral bicarb. 

Another situation to limit bicarb inj is code-Os.  In general, no more than 2 bicarb syringes should be given in a given code, backed up by literature.  This is a valuable intervention pharmacists can make on Codes during the shortage.

Keith has ordered in a very large supply of sodium bicarbonate tablets 650 mg (7.8 meq/tab) for use, so there is PLENTY of tabs for those patients who can take tabs orally or down tube.   The bicarb inj. dose that was not really needed and conserved today for someone needing it urgently in critical situation tomorrow - -  may save a life, vs if we had no bicarb inj to give that patient.      

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Richard Cramer, Pharm. D., FASHP, BCGP
Drug Information Coordinator
Department of Pharmacy