<< Back to News

05/10/17 DC -- sodium bicarb inj situation

From: David Collette
To: Pharmacists
Sent: Wednesday, May 10, 2017 9:33:41 AM
Subject: sodium bicarb inj situation
Attachment: Drug-Shortages-Alert-9-16

I sent an e-mail to the medical staff regarding the bicarb situation. You can read below.

What steps can we all take right now to conserve our dwindling bicarb supply:
 
    * Eliminate or severely restrict the use of biacrb in a Code-0. There is little evidence that bicrab - especially more than an amp or two - makes a difference in arrest survival. It's use in Codes has often been called "medical mythology" whereas in other situations, it is definitely life-saving
    * Before verifying ANY bicarb drip, review the patient carefully. Patients able to take PO should be switched to PO bicarb (or Bicitra). Only those gneneral med/surg patients with documented, clinically-significant metabolic acidosis who are unable to take PO should be on a bicarb drip.
    * Hopefully these restrictions will keep a sufficient supply of IV bicarb available to treat critical patients, such as trauma patients with severe acidosis, oncology patients, CV patients, etc.

Every dose of IV bicarb we save may be a life we can save down the road.

E-mail to physicians:
 
I wanted to update you on the injectable sodium bicarb situation. The national shortage continues with no definite release date for new product. We currently have about 1.400 vials/syringes in stock, which, at current usage levels, will last roughly 4 weeks. Pharmacy has removed all bicarb syringes from crash carts, worked with the Vein Center to remove bicarb from the vein bath formulation, and is working with physicians to use oral bicarb (tablets, Bicitra) whenever possible.

At this point, we ask for your continued support in reducing the use of injectable sodium bicarb:

    * Since there is a scarcity of evidence that bicarb improves survival in Code-0 situations, please limit your use to 1-2 doses (preferably none) in these situations.
    * Additionally, for general medical/surgical patients, please limit the use of bicarb drips to those patients with documented clinically-significant metabolic acidosis who are unable to take PO

I have attached the SCCM statement on bicarb shortage from 2016. Please help sustain our supply of bicarb by following their recommendations for use in a shortage situation. 

Thanks for your efforts in conserving this important drug. We will keep you posted as the situation evolves.

DAVID
--
David R. Collette, Pharm.D., FASHP
Operations Manager, Professional Services
Huntsville Hospital Department of Pharmacy