Compatibility and availability of sodium bicarbonate in total parenteral nutrient solutions

Henann, Neil E.; Jacks, Theron Tim

doi:10.1093/ajhp/42.12.2718

Cited by 2 publications

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“…Sodium bicarbonate has been suggested to be a plausible intravenous source for an alkaline substrate in PN solutions. 20 However, addition of intravenous sodium bicarbonate injection to the PN solution in lieu of potassium acetate or sodium acetate is not recommended. This recommended avoidance is due to the theoretical potential to form calcium carbonate precipitates from the reaction between sodium bicarbonate and calcium-containing additives to the PN solution.…”

Section: Discussionmentioning

confidence: 99%

Avoiding Patient Harm With Parenteral Nutrition During Electrolyte Shortages

et al. 2018

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We report a case of a patient with gastrointestinal dysmotility and substantial drainage losses who required parenteral nutrition (PN) and developed a non-anion gap metabolic acidosis secondary to a shortage of concurrent potassium acetate and sodium acetate PN additives. We describe how severe PN-associated metabolic consequences were averted during this acetate shortage. Summary: The patient with inability to swallow and significant weight loss was admitted to the hospital and given PN after failure to tolerate either gastric or jejunal feeding due to dysmotility and severe abdominal distension and discomfort. PN was initiated and the nasogastric and jejunal tubes were left to low intermittent suction or gravity drainage (average losses of 800 mL and 1600 mL daily, respectively) to reduce abdominal distension. The patient had been stable on PN for approximately 2 months prior to when a shortage in potassium acetate and sodium acetate occurred. As a result, potassium and sodium requirements had to be met with chloride and phosphate salts. The patient developed a non-anion gap metabolic acidosis after 11 days of acetate-free PN. Progression to severe acidemia was avoided by administration of sodium bicarbonate daily for 3 days and replacement of 0.9% sodium chloride supplemental intravenous fluid with lactated ringers solution. Conclusion: This case report illustrates that PN component shortages require clinicians to closely monitor patients who require PN. In addition, clinicians may need to use creative therapeutic strategies to avoid potential serious patient harm during PN component shortages.

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Section: Discussionmentioning

confidence: 99%

Avoiding Patient Harm With Parenteral Nutrition During Electrolyte Shortages

et al. 2018

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“…In another study, the stability of sodium bicarbonate was assessed in total parenteral nutrients, which contain other ingredients as well. 7 A recently published study by Wear et al 8 looked at the stability of 0.05, 0.1, and 0.15 mEq/mL compounded in polyolefin bags containing dextrose 5% or sterile water when stored at 21°C-24°C and 2°C-4°C for up to 7 days.…”

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Extended Stability of Sodium Bicarbonate Infusions Prepared in Polyolefin Bags

Sayre

Prettyman²,

Kaushal

2012

Hosp Pharm

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Purpose To investigate the stability of 0.1 mEq/mL and 0.15 mEq/mL strengths of extemporaneously compounded sodium bicarbonate preparations. Methods Sterile preparations of sodium bicarbonate of 2 strengths (0.1 mEq/mL and 0.15 mEq/mL) were compounded in accordance with USP <797> standards. To carry out the stability testing, these products were stored under 3 temperature conditions: −20°C, 2°C-8°C, and 23°C-25°C. Under the stability studies, pH, particulate matter, and the active content were monitored for 30 days. Results Sodium bicarbonate infusions are stable for 21 days when stored at −20°C or 2°C −8°C and are stable for 7 days when stored at room temperature (23°C-25°C). These data demonstrate that sodium bicarbonate infusions have extended physical and chemical stability after preparation. Conclusions The stability analysis results show that the observed shelf life was far better than the recommended expiration dates. This will allow the hospitals to give longer dating to sodium bicarbonate preparations, provided they are prepared in a sterile environment and are in compliance with USP <797> guidelines.

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Compatibility and availability of sodium bicarbonate in total parenteral nutrient solutions

Cited by 2 publications

References 0 publications

Avoiding Patient Harm With Parenteral Nutrition During Electrolyte Shortages

Avoiding Patient Harm With Parenteral Nutrition During Electrolyte Shortages

Extended Stability of Sodium Bicarbonate Infusions Prepared in Polyolefin Bags

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