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9/19/23 dc Sodium Bicarb injection critical shortage
September 21, 2023

From: "David Collette" <david.collette@hhsys.org>
To: "grp allpharm" <grp_allpharm@hhsys.org>
Cc: "Jonathan White" <jonathan.white@hhsys.org>, "Larry Walker" <larrywalkerhsv@gmail.com>, "Robert W Jr Chappell" <robert.chappell@hhsys.org>, "Tracy Doughty" <tracy.doughty@hhsys.org>, "Arin Zapf" <arin.zapf@hhsys.org>, "Keith Moss" <keith.moss@hhsys.org>, "tiffany ashley" <tiffany.ashley@hhsys.org>
Sent: Tuesday, September 19, 2023 3:34:57 PM
Subject: Sodium bicarb injection critical shortage

Sodium bicarbonate is once again on national backorder and we must take immediate steps to conserve our current supply - approximately 12 days - for the most critical needs. The strict criteria for usage approved by P&T and MEC in November 2017 will need to be followed beginning now so that we can extend our extremely limited supply for as long as possible.

• Documented metabolic acidosis in critically ill patients, including bicarbonate drips in ICUs
• CV surgery
• High-dose methotrexate therapy
• Drug overdoses where alkalization of the urine may be beneficial, including an overdose with a tricyclic antidepressant or aspirin
• Sodium bicarbonate injection should NOT be used in Code Blue situations unless the patient has documented metabolic acidosis

Please work to get bicarb drips stopped wherever possible. Na bicarb tablets and Bicitra are available if oral administration is an option. And, as stated above, bicarb is NOT to be administered via injection in a Code Blue situation unless there is documented metabolic acidosis. We will keep you updated as the situation evolves. DAVID