title: Sodium acetate as a replacement for sodium bicarbonate in medical toxicology: a review.
abstract: 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.
authors: Division of Medical Toxicology, Department of Emergency Medicine, University of Massachusetts Medical School, 55 Lake Avenue North, Worcester, MA, 01655, USA, mark.neavyn@umassmemorial.org.
authors: Mark J
authors: MJ
authors: Neavyn
authors: Edward W
authors: EW
authors: Boyer
authors: Steven B
authors: SB
authors: Bird
authors: Kavita M
authors: KM
authors: Babu
mesh_terms: D000818:Animals; D000931:Antidotes / Q000008:administration & dosage / Q000009:adverse effects / Q000494:pharmacology / Q000627:therapeutic use*; D004305:Dose-Response Relationship, Drug; D057915:Drug Substitution; D004632:Emergency Medical Services; D006801:Humans; D007262:Infusions, Intravenous; D011041:Poisoning / Q000188:drug therapy*; D019346:Sodium Acetate / Q000008:administration & dosage / Q000009:adverse effects / Q000494:pharmacology / Q000627:therapeutic use*; D017693:Sodium Bicarbonate / Q000009:adverse effects / Q000600:supply & distribution / Q000627:therapeutic use; D014655:Vascular Resistance / Q000187:drug effects
chemical_list: D000931:Antidotes; D019346:Sodium Acetate; D017693:Sodium Bicarbonate
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