Pharmacy Shortage Alert: Sodium Bicarbonate

14 Oct 2018

The supply of sodium bicarbonate is rapidly depleting at Salem Health.

  Bicarbonate use needs to be limited to appropriate indications (similar to the previous shortage in 2017):

• Severe acidosis (pH less than 7.15)
• Salicylate or tricyclic antidepressant overdose
• Hyperkalemia with electrocardiogram changes

Do not use sodium bicarbonate for:

• Contrast nephropathy prophylaxis
• Diabetic ketoacidosis
• Rhabdomyolysis (no improvement over aggressive fluid resuscitation)
• Acidosis with a pH greater than 7.15
• Buffering lidocaine or other local anesthetics

Sodium bicarbonate is being pulled from many omnicells to support the supply in code carts.

What to do instead:

• Your floor pharmacist can help you get a one-time infusion for patients in whom it is indicated.
• Use oral bicarbonate (as able) for indications like high-dose methotrexate urinary alkalization.

Please follow the guidelines above until the supply situation improves.