Many of you are probably facing the same drug shortages this week that we are experiencing at Washington University in St. Louis, that being Calcium Chloride and Sodium Bicarbonate. We have enough supply of Calcium Chloride to support major trauma with MTP and Liver Transplants, but Sodium Bicarb reserves have now been exhausted. THAM is no longer commercially available, leaving only Sodium Acetate. Peter Nagele and I are actively engaged in a discussion with our pharmacists about use of Sodium Acetate in major trauma and the potential to worsen metabolic acidosis given metabolism of Sodium Acetate is partially hepatic metabolism and the remainder in the skeletal muscle (poorly perfused in hypovolemic or hemorrhagic shock). We were interested in what our TAS colleagues are doing in their home institutions during this period of drug shortage?
Jason R Gillihan, MD
I am interested as well. Especially since I do liver transplants. It sounds like Acetate would not be a good solution for a liver transplant.
Correct. Our director of liver transplant has done the following: secured Plasmalyte for crystalloid use in liver txp, reserved 2 amps of Sodium Bicarb from our emergency reserves to be placed in our liver txp drug box for use during anhepatic phase and reperfusion (attending discretion for use), and we have worked with our pharmacy to create a 150 mEq Sodium Acetate in D5W 1 liter solution for any other needs. A true problem still for trauma and cases requiring MTP for sure.
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