Description of Sodium acetate trihydrate

Sodium acetate is an intravenous alkalizing agent used in the management of mild to moderate metabolic acidosis. Sodium acetate and other bicarbonate precursors (e.g., sodium citrate, sodium lactate) are used to overcome the chemical and physical incompatibilities associated with administration of parenteral bicarbonate. Sodium acetate is also used as a source of sodium in large volume parenterals to prevent or correct hyponatremia in patients with restricted intake. Sodium acetate is useful as a source of sodium in parenteral nutrition solutions, assisting to maintain metabolic balance of chloride and bicarbonate. Let us find out more about Sodium acetate trihydrate.

Mechanism of Action of Sodium acetate trihydrate

Acetate is metabolized systemically to bicarbonate on an equimolar basis when the body’s acid-base balance is altered as a result of bicarbonate deficiency (metabolic acidosis). To form bicarbonate, acetate is slowly hydrolyzed to carbon dioxide and water, which are then converted to bicarbonate by the addition of a hydrogen ion. These conversions take place in the liver as well as in the extrahepatic organs. Thus, the actions of sodium acetate mimic those of sodium bicarbonate . Sodium acetate used as a source of sodium, an important extracellular cation which functions in fluid and electrolyte balance, osmotic pressure control, and water distribution.

Contraindications/Precautions: Requires dilution in a large volume fluid prior to administration. Bartter’s syndrome, breast-feeding, children, cirrhosis, Cushing’s syndrome, edema, elderly, heart failure, hepatic disease, hyperaldosteronism, hypernatremia, hypocalcemia, hypokalemia, metabolic alkalosis, pregnancy, renal disease, renal failure, renal impairment, respiratory alkalosis. Avoid extravasation during infusion.

Drug Interactions:
Chlorpropamide, lithium, salicylates, tetracyclines: Urinary alkalization increases the excretion of chlorpropamide, lithium, salicylates, and tetracyclines.
Corticosteroids: Chronic coadministration can result in sodium retention. The potential for this pharmacodynamic interaction is greatest with fludrocortisone.
Dextroamphetamine, ephedrine, mecamylamine, mexiletine,pseudoephedrine, quinidine: Sodium bicarbonate-induced urinary alkalization can increase the half-life of these drugs.
Methenamine: Alkalinization of the urine may reduce the effectiveness of methenamine by inhibiting its conversion to formaldehyde.

Adverse Reactions of Sodium acetate trihydrate

Hypernatremia, hyperosmolarity, hypocalcemia, hypokalemic metabolic alkalosis, injection site reaction (including cellulitis), lactic acidosis, peripheral edema, pulmonary edema, seizures, tetany, thrombosis, tremor.

Available as:
Sodium acetate injection, 2 mEq/ml (16.4%), various manufacturers
Per ml:
acetate 2 mEq
sodium 2 mEq
Available in 20, 50, 100 ml vials.

Sodium acetate injection, 4 mEq/ml (32.8%), various manufacturers
Per ml:
acetate 4 mEq
sodium 4 mEq
Available in 50 and 100 ml vials.

Basic details of Sodium acetate trihydrate
Requires Prescription: Yes

Generic Name
Sodium Acetate
Therapeutic Class
Parenteral Electrolyte, Sodium

FDA-Label Indications
Hyponatremia, In patients with restricted or no oral intake; Treatment and Prophylaxis: Adult
Hyponatremia, In patients with restricted or no oral intake; Treatment and Prophylaxis: Pediatric

Serious Effects
Endocrine metabolic: Hypervolemia, Metabolic alkalosis
Other: Aluminum poisoning, Hypernatremia

Administration
Intravenous: Must be diluted in a larger volume of fluid prior to intravenous administration

How Supplied – Trade
Sodium acetate Novaplus: Intravenous Solution: 2 MEQ/1 ML

How Supplied – Generic
Intravenous Solution: 2 MEQ/1 ML, 4 MEQ/1 ML

Adult Dose of Sodium acetate trihydrate

General Dosage Information: Sodium acetate has been used to alkalize urine or serum in place of sodium bicarbonate during shortages. No difference was observed in the achievement of urine pH of 8 or greater when either sodium bicarbonate or sodium acetate was administered in patients taking high-dose methotrexate therapy .
General Dosage Information: Bolus treatment of QRS widening, severe arrhythmias, and salicylism: Use 1 mEq/kg sodium acetate infused IV over 15 to 20 minutes to replace 1 to 2 mEq/kg sodium bicarbonate in order to reach serum pH of 7.5 to 7.55 .
General Dosage Information: Maintenance of alkaline serum pH, or to alkalinize urine: Give 150 mEq sodium acetate diluted to 1 L with D5W, and infuse at twice the maintenance rate .
Hyponatremia, In patients with restricted or no oral intake; Treatment and Prophylaxis: Dose and rate are dependent upon individual patient needs .

Pediatric Dose of Sodium acetate trihydrate

Hyponatremia, In patients with restricted or no oral intake; Treatment and Prophylaxis: Dose and rate are dependent upon individual patient needs .