Sodium Acetate as a Replacement for Sodium Bicarbonate in Medical Toxicology: a Review
Department of Emergency Medicine
Sodium Acetate; Sodium Bicarbonate; Antidotes
Emergency Medicine | Medical Toxicology
Sodium bicarbonate is central to the treatment of many poisonings. When it was placed on the FDA drug shortage list in 2012, alternative treatment strategies to specific poisonings were considered. Many hospital pharmacies, poison centers, and medical toxicologists proposed sodium acetate as an adequate alternative, despite a paucity of data to support its use in medical toxicology. The intention of this review is to educate the clinician on the use of sodium acetate and to advise them on the potential adverse events when given in excess. We conducted a literature search focused on the pharmacology of sodium acetate, its use as a buffer in pathologic acidemia and dialysis baths, and potential adverse events associated with excess sodium acetate infusion. It appears safe to replace sodium bicarbonate infusion with sodium acetate on an equimolar basis. The metabolism of acetate, however, is more complex than bicarbonate. Future prospective studies will be needed to confirm the efficacy of sodium acetate in the treatment of the poisoned patient.
DOI of Published Version
J Med Toxicol. 2013 Apr 30. Link to article on publisher's site
Journal of medical toxicology : official journal of the American College of Medical Toxicology
Neavyn, Mark; Boyer, Edward W.; Bird, Steven B.; and Babu, Kavita, "Sodium Acetate as a Replacement for Sodium Bicarbonate in Medical Toxicology: a Review" (2013). University of Massachusetts Medical School Faculty Publications. 68.