UMEM Educational Pearls

Category: Toxicology

Title: If bicarbonate is in short supply: what to do

Keywords: bicarbonate, acetate, TCA, salicylate, poisoning, alkalinization (PubMed Search)

Posted: 8/1/2013 by Ellen Lemkin, MD, PharmD
Click here to contact Ellen Lemkin, MD, PharmD

A recent article was published in the Journal of Medical Toxicology reviewing the use of sodium acetate for treatment of overdoses and poisonings.


Acetate is metabolized to bicarbonate, causing a net increase in cations; this increased strong anion difference leads to alkalemia.


It has been used to treat acidosis in uremia, diarrhea, and in trauma patients.


Although no studies have been conducted using sodium acetate as an antidote, if bicarbonate is unavailable this is a viable option for management of salicylate overdose, and for qrs widening or arrhythmias due to overdoses.


Sodium acetate, if given rapidly (in animals and hemodialysis patients), causes myocardial depression, hypotension, and hypopnea.


The bolus dose should be given as 1-2 mEq/L given over 15-20 minutes. For the maintenance infusion, dilute 150 mEq diluted to 1 L in dextrose 5%, infuse at 2X the maintenance rate.


It must be diluted in dextrose 5% and NOT normal saline.




Neavyn MJ, Boyer EW, Bird SB, Babu KM. Sodium Acetate as a Replacement for Sodium Bicarbonate in Medical Toxicology: a Review. Published online 30 April 2013. J. Med. Toxicol.