Download IV sodium bicarbonate shortage-adult plan

IV sodium bicarbonate shortage-adult plan
(Update on Critical drug shortage-November 2012)
What? The critical shortage of sodium bicarbonate is becoming more severe. Due
to the severity of the shortage, the following action plan should be followed:
Prescribers should utilize alternatives where possible. Every order generated in CPOE
for sodium bicarbonate will result in a phone call from the pharmacist to the
prescriber to ensure that the medication is being used for a critical care or an
emergent situation and that an alternative cannot be utilized.
The following may be emergent situations, with recommended alternatives indicated
where available:
•
Management of severe metabolic acidosis, lactic acidosis, or diabetic
ketoacidosis
•
Management of overdose of certain drugs, including tricyclic antidepressants
and aspirin
•
Adult ACLS:
Prolonged acidosis due to cardiac arrest: Routine use of sodium bicarbonate is
NOT recommended for patients in cardiac arrest.
Par levels of sodium bicarbonate on the Emery House Carts have been
reduced, with each cart containing only 1 vial/syringe. Stock on Broselow
Carts has been reduced from 3 to 1 of 8.4% 50 mL and from 4 to 2 of 4.2%
10 mL. Further operational changes may be made in the future, but will be
communicated out to staff prior to implementation.
•
Treatment of emergent hyperkalemia
Alternatives may include:
Calcium chloride or calcium gluconate, plus dextrose and regular insulin, plus
nebulized albuterol
•
Tumor Lysis Syndrome
As previously approved by P&T, the following is not an emergent use for sodium
bicarbonate. As an alternative exists, orders will be interchanged by the pharmacist
as follows:
•
Prevention of contrast-induced nephropathy (CIN):
• Pre Procedure: Sodium Bicarbonate 150mEq in D5W 1000ml at
3ml/kg/hr X 1 hour prior to Sodium Chloride 0.9% 1000 ml 1ml/kg/hr
X 12 hours.
• Post Procedure: Sodium Bicarbonate 150mEq in D5W 1000ml at
1ml/kg/hr X 6 hours to Sodium Chloride 0.9% 1000 ml 1ml/kg/hr X 12
hours.
When? Effective immediately
Why? IV sodium bicarbonate is in critical supply at Methodist and on national
shortage. The shortage is due to decreased production and distribution by all
manufacturers. The anticipated resolution date of the shortage is at least through
November 2012. Recently, the shortage for IV sodium bicarbonate has become more
severe due to the voluntary recall of all drug products by one of the distributors of
sodium bicarbonate.
References:
1. Lexicomp. Sodium Bicarbonate. Accessed on 23 October 2012.
2. Micromedex. Sodium Bicarbonate. Accessed on 23 October 2012.
3. Kitabchi AE, Umpierrez GE, Miles JM, Fisher JN. Hyperglycemic crises in adult patients with
diabetes. Diabetes Care 2009; 32:1335.
4. Kraut JA, Madias NE. Treatment of acute metabolic acidosis: a pathophysiologic approach. Nat
Rev Nephrol 2012; 8:589.
5. Advanced Life Support Chapter Collaborators. Part 8: Advanced life support: 2010 International
Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With
Treatment Recommendations. Circulation. 2010 Oct 19;122(16 Suppl 2):S345421http://circ.ahajournals.org/content/122/18_suppl_3/S729.ful
6. Advanced Life Support Chapter Collaborators. Part 12: Advanced life support: 2010 International
Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With
Treatment Recommendations. Circulation. 2010 Oct 19;122(16 Suppl 2): S829-861
http://circ.ahajournals.org/content/122/18_suppl_3/S829.full.pdf+html
7. Sabatini S, Kurtzman NA. Bicarbonate therapy in severe metabolic acidosis. J Am Soc Nephrol
2009; 20:692.
8. Coiffier B, Altman A, Pui CH, et al. Guidelines for the management of pediatric and adult tumor
lysis syndrome: an evidence-based review. J Clin Oncol 2008; 26:2767.