From: Bryan Lich, CCP
Please be advised that you will soon be experiencing a Biarb shortage at your hospital, so please use it sparingly.
Sodium Bicarbonate Injection
[29 January 2016]
Products Affected – Description
8.4%, 50 mL syringe, 10 count (NDC 76329-3352-01)
8.4%, 50 mL syringe, 10 count (NDC 00548-3352-01)Sodium Bicarbonate injection, Hospira
4.2%, 10 mL LifeShield syringe, 10 count (NDC 00409-5534-34)
7.5%, 50 mL LifeShield syringe, 10 count (NDC 00409-4916-34)
8.4%, 10 mL syringe, 10 count (NDC 00409-4900-34)
8.4%, 50 mL LifeShield syringe, 10 count (NDC 00409-6637-34)
Reason for the Shortage
- Amphastar has sodium bicarbonate on shortage due to increased demand and has a new NDC number for the product.
- Fresenius Kabi is not currently manufacturing sodium bicarbonate 4.2% 5 mL vials.
- Hospira has sodium bicarbonate on shortage due to manufacturing delays.
- Hospira is the sole supplier of the 4.2% 10 mL syringes used in pediatric patients.
Estimated Resupply Dates
- Amphastar (IMS) has sodium bicarbonate 8.4% 50 mL syringes on intermittent back order and the company is regularly releasing product.
- Hospira has sodium bicarbonate 8.4% 10 mL syringes, 8.4% 50 mL LifeShield syringes, and 4.2% 10 mL LifeShield syringes on back order and the company estimates a release date of April 2016. Sodium bicarbonate 7.5% 50 mL LifeShield syringes and 8.4% 50 mL vials are available in limited supply.
- Sodium Acetate Injection — Current
- Sodium Lactate Injection — Resolved
- Tromethamine Injection — Resolved
January 29 and 20, 2016; December 11, November 12, September 15, August 11, July 1, June 15, May 4, April 20, March 5, 2015, University of Utah, Drug Information Service. Copyright 2016, Drug Information Service, University of Utah, Salt Lake City, UT.
– See more at: https://www.ashp.org/menu/DrugShortages/ResolvedShortages/bulletin.aspx?id=788#sthash.oBsivUpw.dpuf
UPDATE: 4/9/2012 See Comments Section for manufacturing links in India
Thanks Bij !
I hate being the last to know, but today after my second heart, our OR pharmacist informed me that the was a serious shortage of Bicarb, apparently nation wide, and that what he had in stock was pretty much it.
We discussed alternative sources, so I told him I would look to the international community to see if there are other readily available sources, or if they are experiencing the same thing.
A shout out to the Brits, Canadians, the Aussies, The Indians, the Italians, the New Zealanders, All things Mexico, and all of you that come here so often…
Got any ideas or manufacturing contacts that you can share ?
IF SO : Post them on the comments section of this post plz ?
Here’s the Deal…
(Click on Image to Enlarge)
There’s a lot of guessing going on regarding release dates and quantities to be made available.
Here is a brief description of Sodium Bicarb and it’s effects…
Those who advocate the use of sodium bicarbonate for lactic acidosis generally use the following chain of reasoning (explicitly or implicitly):
- A low pH, in and of itself, is harmful (most notably by impairing cardiovascular function).
- Sodium bicarbonate can increase the pH when infused IV.
- Raising the pH with sodium bicarbonate improves cardiovascular function or some other relevant outcome.
- Any adverse effects of sodium bicarbonate are outweighed by its benefits.
Is Lactic Acidosis Bad ?
Cardiac contractile response to catecholamines is also impaired by acidosis, perhaps mediated by a decline in β-receptors on the cell surface.
Other potentially detrimental cardiovascular effects of acidosis include reduced resuscitability from induced ventricular fibrillation, impaired load tolerance of the right ventricle,and altered renal blood flow (both increased and decreased, depending on the degree of acidemia).
Diaphragmatic contractility is reduced also by respiratory acidosis, but apparently not by metabolic acidosis.39
Paradoxically, acidosis may have protective effects in critical illness. A low pH has been shown to delay the onset of cell death in isolated hepatocytes exposed to anoxiaand to chemical hypoxia. Correcting the pH took away the protective effect and accelerated cell death. In addition, acidosis during reperfusion limits myocardial infarct size.
In summary, although a very low pH has negative inotropic effects in isolated hearts, the whole-body response in patients is much less clearly detrimental. Although clinical shock and metabolic acidosis often coincide, the striking discordance between the clinical course and outcome of patients with (usually septic) lactic acidosis compared with those who have DKA or ventilatory failure suggests that the low pH itself does not crucially underpin the hemodynamic collapse of these ill patients. Independent of the acidemia, the lactate ion may be significant, because lactate buffered to a pH of 7.4 can cause decreased cardiac contractility in animal models.
Does Sodium Bicarbonatea have Negative Side Effects ?
The most obvious side effects of sodium bicarbonate are the fluid and sodium load. This can cause hypervolemia, hyperosmolarity, and hypernatremia.
Sodium bicarbonate given as a rapid IV bolus can cause a transient fall in mean arterial pressure and a transient rise in intracranial pressure that is probably related to its hypertonicity, and this is alleviated when given as a slow IV infusion.
Is THAM the Only Alternative ?
Although I have been in the field for quite awhile- I have never used THAM but some of my colleagues have.
Any input on dosing regimens- and tying them into a correlation of current Bicarb dosing (ie; what amount of Tham will have the same effects as 50 MEQ of NaHCO3- ?)
Please share details and excuse my lack of experience and insight here.
Continue To: THAM