Key points
- We recommend to consult your poison centre with the use of this antidote
- Use only in the event of a shortage of sodium bicarbonate.
- WARNING: Not to be confused with sodium bicarbonate.
- Do not administer by direct IV. Dilute before administering.
- Sodium acetate is an irritant.
- One vial of sodium acetate does not equal one vial or syringe of sodium bicarbonate.
- 1 mmol of (sodium) acetate is equal to 1 mmol of (sodium) bicarbonate, since sodium acetate is metabolized into bicarbonate on an equimolar basis.
- Sodium acetate has a distinctive odour similar to that of vinegar.
- Blood pH should be monitored to make sure it does not exceed 7.55.
+ Synonyms and other terms
- NaOAc
- Sodium ethanoate
+ Indications
Use only in the event of a shortage of sodium bicarbonate:
- Cardiotoxicity involving QRS with right ventricular delay, hypotension or ventricular arrhythmia caused by sodium channel blockers, such as tricyclic antidepressants, antiarrhythmic drugs (class “Ia” or “Ic,” etc.).
- Blood alkalinization to reduce the distribution of salicylates in the CNS.
- Urinary alkalinization due to salicylate poisoning.
- Correction of metabolic acidosis caused by methanol or ethylene glycol poisoning or secondary to lactic acidosis.
+ Dosage
+ Pediatric Dose
Doses must be prescribed in mmol of acetate.
- Cardiotoxicity: 1 mmol/kg by slow IV infusion.
- Blood alkalinization: 1 mmol/kg by slow IV infusion. Then go to urinary alkalinization dose and maintain blood pH at approx. 7.50.
- Urinary alkalinization (aim for urinary pH greater than 7.5): 150 mmol of sodium acetate (37.5 ml) diluted in 1000 ml of D5W (final volume 1037.5 ml; final concentration 0.14 mmol of acetate/ml) by continuous IV infusion of 1-2 ml/kg/h up to a maximum of 150-200 ml/h.
- It may be necessary to add KCI to a basic IV solution through a second line in order to maintain serum potassium at approximately 4 mmol/L.
- Correction of metabolic acidosis: 1 mmol/kg by slow IV infusion. Repeat as needed until blood pH is superior or equal to 7.2.
+ Adult Dose
Doses must be prescribed in mmol of acetate.
- Cardiotoxicity: 1 mmol/kg by slow IV infusion. Repeat as needed until a blood pH of 7.45-7.55.
- Blood alkalinization: 1 mmol/kg by slow IV infusion. Then go to urinary alkalinization dose and maintain blood pH at approx. 7.50.
- Urinary alkalinization (aim for urinary pH greater than 7.5): 150 mmol of sodium acetate (37.5 ml) diluted in 1000 ml of D5W) final volume 1037.5 ml; final concentration 0.14 mmol of acetate/ml) by continuous IV infusion of 1-2 ml/kg/h up to a maximum of 150-200 ml/h.
- It may be necessary to add KCI to a basic IV solution through a second line in order to maintain serum potassium at approximately 4 mmol/L.
- Correction of metabolic acidosis: 1 mmol/kg by slow IV infusion. Repeat as needed until blood pH is greater than 7.2.
+ Renal Impairment
Watch out for fluid overdose (high sodium levels).
+ Hepatic Impairment
No data suggests that the dose should be modified for short-term use.
+ Hemodialysis Patient
No data suggests that the dose should be modified for short-term use.
+ Pregnancy
- The safety of large doses of sodium acetate has not be demonstrated.
- Do not hesitate to use during pregnancy if the anticipated toxic effects pose a significant risk of morbidity or mortality.
- No data suggests that the dose should be modified for short-term use.
+ Obese or Overweight Patient
No data suggests that the dose should be modified for short-term use.
+ Adverse effects
- Hypernatremia (due to high sodium content), hypokalemia, fluid overload, excessive alkalinization.
+ Monitoring
- Vital signs
- Serum electrolytes (With salicylate poisoning, urinary alkalinization will not be possible if serum potassium is less than 3,5-4 mmol/L)
- Serum calcium
- Blood gases
- Urinary pH
+ End of treatment
- Cardiotoxicity: When QRS is less than 100 milliseconds or when blood pressure is stabilized and arrhythmias are corrected.
- Blood alkalinization: When blood pH is 7.45-7.55.
- Urinary alkalinization:
- When major clinical symptoms have resolved (except tinnitus), and;
- the salicylates levels have decreased for two consecutive readings, and;
- is less than 2.5 mmol/L (345.25 mg/L)
- Correction of metabolic acidosis: When blood pH is greater than 7.20.
+ Special Notes on Administration
Intravenous Route (IV)
- Direct IV: Not recommended (risk of hypotension).
- Slow IV Infusion
- Administer using a volumetric pump or syringe pump.
- Dilute dose in a compatible solution (preferably D5W) in order to obtain a final concentration less than 0.5 mmol/ml for a peripheral line (or 1 mmol/ml for a central line).
- Administer over 15-20 min. at a maximum rate of 1 mmol/kg.
- Continuous IV Infusion
- Recommended only for urinary alkalinization.
- Administer using a volumetric pump.
- Preparation method for a solution with a concentration of 32.8% (4 mmol/ml):
- 150 mmol (37.5 ml) in 1000 ml of a compatible solution (preferably D5W).
- Final volume: 1037.5 ml.
- Final concentration: 0.144 mmol /ml.
Subcutaneous Route (SC)
- Do not administer by this route.
Intramuscular Route (IM)
- Do not administer by this route.
Intraosseous Route (IO)
- Do not administer by this route.
Compatibility
Partial list only. Consult the pharmacist on duty at your health care facility.
- Compatible solutions: D5W (preferred choice), combinations of dextrose-sodium. (choose a low-sodium solution)
- Y-site compatibility: Aminophylline, atenolol, dexmedetomidine, digoxin, diltiazem, diphenhydramine, dobutamine, dopamine, esmolol, famotidine, fentanyl, furosemide, heparin sodium, labetalol, lidocaine, lorazepam, magnesium (sulfate), mannitol, metoclopramide, milrinone, morphine, naloxone, sodium nitroprusside, octreotide, ondansetron, pancuronium, pentobarbital, phenobarbital, phenylephrine, potassium (chloride), propranolol, ranitidine, rocuronium, vasopressin, verapamil.
- Y-site incompatibility: Amiodarone, diazepam, midazolam, pantoprazole, phenytoin.
Stability
- Store unused vials at room temperature (20°C-25°C).
- Discard vial 4 hours after opening.
- Diluted in compatible solutions: Consider maximum stability to be 24 h.
+ Available products
- Sodium acetate for injection USP 200 mmol of acetate per 50-ml (32.8%; 328 mg/ml; 4 mmol/ml; 4 mEq/ml), Fresenius Kabi on allocation, DIN 02139529 (50 mL or 100 mL vials)
- Sodium acetate for injection USP 200 mmol of acetate per 50-ml vial (32.8%; 328 mg/ml; 4 mmol/ml; 4 mEq/ml), Omega, DIN 02181746
- Acetate content (OAc): 328 mg/ml; 4 mmol/ml; 4 mEq/ml.
- Sodium content (Na): 96 mg/ml; 4 mmol/ml; 4 mEq/ml.
- Osmolarity: 8000 mOsm/L; 8 mOsm/ml.
+ Amount required to treat a person weighting 70kg during 24 hours
- No specific recommendation at this time.
+ References
Considerations, Pharmacotherapeutic. n.d. “Treat Underlying Shock And/or Source of Acidemia. Diabetic Ketoacidosis Sodium Bicarbonate Not Treat Underlying Ketogenesis. Recommended.”
Neavyn, Mark J., Edward W. Boyer, Steven B. Bird, and Kavita M. Babu. 2013. “Sodium Acetate as a Replacement for Sodium Bicarbonate in Medical Toxicology: A Review.” Journal of Medical Toxicology: Official Journal of the American College of Medical Toxicology 9 (3):250–54.
Proudfoot, A. T., E. P. Krenzelok, and J. A. Vale. 2004. “Position Paper on Urine Alkalinization.” Journal of Toxicology. Clinical Toxicology 42 (1):1–26.
Sodium acetate In: Lexi-Comp OnlineTM , Trissel’sTM 2 Clinical Pharmaceutics Database, Hudson, Ohio: Lexi-Comp, Inc.; [cited 2017 Jun]
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