From: David Collette
To: Pharmacists
Sent: Friday, July 28, 2017 10:46:50 AM
Subject: IV bicarb shortage

I sent out an email to the medical staff today informing them that the bicarb injection shortage continues with no end in sight. The text of that email was as follows:

The critical national shortage of sodium bicarbonate injection continues. Currently there is no reliable release date from Prizer/Hospira or IMS (the two major manufacturers); additionally, we were unable to purchase bicarb injection from a compounding pharmacy due to issues that were uncovered by the FDA.

Our usage of bicarb injection had been holding steady at 10-15 doses per day during the fist few months of the shortage, but usage has slowly increased to 20-30 doses per day recently, leaving us with approximately a 40-day supply on hand.

Please help us conserve our sodium bicarb injection supply by using only for indications approved by the HH Medical Staff leadership )and by using the smallest dose possible):

• CV surgery

• high-dose methotrexate

• certain drug overdoses (e.g., amitriptyline)

• severe documented metabolic acidosis in critically ill patients in an ICU setting

The Medical Staff further approved that bicarb is NOT to be used during Code-0 situations due to the scarcity of evidence showing its benefit. 

Oral bicarb is in plentiful supply and has been successfully used in many situations where alkalinization was needed.

Thank you for your cooperation with this and other drug shortages. We will keep you apprised of the situation as it evolves and (hopefully) resolves. 

Please continue to enforce these usage restrictions as approved by HH Medical Staff leadership and the P&T Committee. If our usage continues at the current rate, we will have less than a 2-months supply; if usage increases, we are looking at only a few weeks. As always, you are welcome to have an insistent prescriber contact me or you can call me and give me his/her contact info. 

Thanks to everyone who has helped with this and other shortages. DAVID

--
David R. Collette, Pharm.D., FASHP
Operations Manager, Professional Services