Bernice Lee, PharmD
Yale New Haven Hospital
New Haven, Connecticut
Disclosure information not submitted.
Kim Walker, PharmD, MPH
Sr. Pharmacy Specialist Data Analytics & Automation
Yale New Haven Health, United States
Disclosure information not submitted.
Mahmoud Ammar, BCCCP, PharmD, BCPS,
Critical Care Pharmacist
Yale New Haven Hospital
New Haven, Connecticut
Disclosure information not submitted.
Paul Ahearn, BCCCP, BCPS, PharmD
Clinical Pharmacy Specialist I, Critical Care
Yale New Haven Health, United States
Disclosure information not submitted.
Mujtaba Khan, PharmD, MBA
PGY1 Waterbury Hospital Pharmacy Resident
Waterbury Hospital, United States
Disclosure information not submitted.
Bryan McGill, PharmD,
Senior Pharmacy Specialist, Critical Care
Yale New Haven Health, United States
Disclosure information not submitted.
Title: Sodium Acetate versus Sodium Bicarbonate in Patients with Acidemia
Introduction: Intravenous (IV) sodium bicarbonate (SB) infusions are used to prevent or reverse acidemia. IV sodium acetate (SA) is considered an alternative therapy, though support for its use is limited. This study aims to evaluate the efficacy of SA in managing acidemia in comparison to SB.
Methods: This was a multi-center retrospective cohort study that included adult patients with acidemia (pH less than or equal to 7.35) who received SB infusions (September 1, 2019 - November 30, 2019) or SA infusions (September 1, 2020 - November 30, 2020) for at least 24 hours and a maximum of 7 days. The primary outcome evaluated was the change in serum bicarbonate at 24 hours post-infusion initiation from baseline. Secondary outcomes evaluated included serum bicarbonate and pH values at 24 hours and hospital length of stay.
Results: 1,126 patients were screened and 444 patients were included (SB = 235 patients, SA = 209 patients). Using median (IQR), baseline characteristics were well matched except for age (SB, 67 years (54 – 75) years vs. SA, 71 years (60 – 79) years, p=0.02). For the therapy metrics, there were differences in the duration of infusion (SB, 38.4 hours (28.1 – 53.2) hours vs. SA, 44.8 hours (29.7 – 67.3) hours, p=0.03) and total mEq of base administered (SB, 339.4 mEq (194.6 – 584.7) mEq vs. SA, 467.5 mEq (336.5 – 838.4) mEq, p< 0.01). Serum bicarbonate (SB, 15.6 mmol/L (12.1 – 19.9) mmol/L vs. SA, 19.5 mmol/L (16.5 – 22.8) mmol/L, p< 0.01) and change in serum bicarbonate at 24-hour from baseline (SB, 0 mmol/L (0 – 3.5) mmol/L vs. SA, 3.8 mmol/L (0.4 – 6.7) mmol/L, p< 0.01) were significantly different at 24 hours. For secondary outcomes there was no difference in hospital length of stay (SB, 8 days (4.1 – 17.2) days vs. SA, 7.9 days (4.1 – 16.1) days p=0.72) but a difference was observed in pH at 24 hours (SB, 7.29 (7.21 – 7.35) vs. SA, 7.33 (7.24 – 7.41), p=0.02).
Conclusions: Based on the results of this study, SA may be considered for the management of acidemia as an alternative to SB. There was a difference in the pH at 24 hours between the two groups, however, it is not likely clinically significant and further studies are needed to confirm these findings.