Dosage Forms
Excipient information presented when available (limited, particularly for generics); consult specific product labeling.
Solution, Intravenous, as anhydrous:
Generic: 2 mEq/mL (20 mL, 50 mL, 100 mL); 4 mEq/mL (50 mL)
Solution, Intravenous, as anhydrous [preservative free]:
Generic: 4 mEq/mL (100 mL)
Use: Labeled Indications
Sodium source in large volume IV fluids to prevent or correct hyponatremia in patients with restricted intake; used to counter acidosis through conversion to bicarbonate
Contraindications
Hypernatremia and fluid retention
Dosage and Administration
Dosing: Adult
Note: Sodium acetate is metabolized to bicarbonate on an equimolar basis outside the liver; administer in large volume IV fluids as a sodium source. Refer to Sodium Bicarbonate monograph.
Maintenance electrolyte requirements of sodium in parenteral nutrition solutions:
Acetate maintenance electrolyte requirement: IV: Acetate and chloride content should be adjusted to maintain acid-base balance with parenteral nutrition; use equal amounts of acetate and chloride and adjust ratio based on individual patient needs (Mirtallo 2004).
Sodium maintenance electrolyte requirement (combination of chloride and acetate, where applicable): IV: 1 to 2 mEq/kg/24 hours; customize amounts based on individual patient needs (Mirtallo 2004). General maximum sodium acetate: 100 to 150 mEq/24 hours.
Dosing: Geriatric
Refer to adult dosing.
Dosing: Pediatric
Note: Maintenance sodium should be incorporated into the patient's maintenance IV fluids; acid/base balance should be considered when selecting a sodium salt; acetate is converted to bicarbonate on an equimolar basis within the body and may affect serum pH.
Parenteral nutrition; maintenance sodium requirement: Note: A combination of salt forms may be necessary to fulfill sodium requirement (ASPEN [Mirtallo 2004]).
Infants and Children ≤50 kg: IV: 2 to 5 mEq/kg/day of sodium as an additive to parenteral nutrition solution.
Children >50 kg and Adolescents: IV: 1 to 2 mEq/kg/day of sodium as an additive to parenteral nutrition solution.
Metabolic acidosis: Limited data available: Infants, Children, and Adolescents: Each mEq of acetate is converted 1:1 to mEq of bicarbonate (HCO3-); dosage should be based on standard dosing formulas if blood gases and pH measurements are available. Refer to the Sodium Bicarbonate monograph for specific dosing details and equations.
Administration
IV: Must be diluted prior to IV administration; infuse hypertonic solutions (eg, >2.8% sodium acetate in sterile water [2.8% sodium acetate in sterile water has osmolarity approximately equivalent to 2% sodium chloride]) via a central line (Mortimer, 2006; Suarez, 2004). If diluted in D5W or other solution, the osmolarity may be higher requiring central line administration at a lower sodium acetate concentration.
Consult individual institutional policies and procedures.
Dietary Considerations
Sodium acetate anhydrous (2 mEq/mL): 1 mL = 164 mg sodium acetate anhydrous = 2 mEq of sodium (46 mg) and acetate (118 mg)
Storage
Store at room temperature of 20°C to 25°C (68°F to 77°F).
Drug Interactions
There are no known significant interactions.
Adverse Reactions
1% to 10%:
Cardiovascular: Localized phlebitis, thrombosis
Endocrine & metabolic: Electrolyte disturbance (dilution of serum electrolytes), hypernatremia, hypervolemia, hypocalcemia, hypokalemia, metabolic alkalosis, water intoxication
Gastrointestinal: Abdominal distention, flatulence
Respiratory: Pulmonary edema
Warnings/Precautions
Concerns related to adverse effects:
- Hypernatremia: Close monitoring of serum sodium concentrations is needed to avoid hypernatremia.
Disease-related concerns:
- Acid/base disorders: Use with caution in patients with acid/base alterations; contains acetate, monitor closely during acid/base correction.
- Edema: Use with caution in edematous patients.
- Heart failure (HF): Use extreme caution in patients with HF; monitor closely for edema.
- Hepatic impairment: Use with caution in patients with severe hepatic impairment.
- Renal impairment: Use with caution in patients with renal impairment; monitor serum sodium concentrations closely.
Dosage form specific issues:
- Aluminum: The parenteral product may contain aluminum; toxic aluminum concentrations may be seen with high doses, prolonged use, or renal dysfunction. Premature neonates are at higher risk due to immature renal function and aluminum intake from other parenteral sources. Parenteral aluminum exposure of >4 to 5 mcg/kg/day is associated with CNS and bone toxicity; tissue loading may occur at lower doses (Federal Register, 2002). See manufacturer’s labeling.
Other warnings/precautions:
- Extravasation: Avoid extravasation.
Pregnancy
Pregnancy Risk Factor
C
Pregnancy Considerations
Animal reproduction studies have not been conducted. Sodium requirements do not change during pregnancy (IOM, 2004).
Patient Education
- Discuss specific use of drug and side effects with patient as it relates to treatment. (HCAHPS: During this hospital stay, were you given any medicine that you had not taken before? Before giving you any new medicine, how often did hospital staff tell you what the medicine was for? How often did hospital staff describe possible side effects in a way you could understand?)
- Have patient report immediately to prescriber signs of electrolyte problems (mood changes, confusion, muscle pain or weakness, abnormal heartbeat, seizures, lack of appetite, or severe nausea or vomiting), shortness of breath, excessive weight gain, or swelling of arms or legs (HCAHPS).
- Educate patient about signs of a significant reaction (eg, wheezing; chest tightness; fever; itching; bad cough; blue skin color; seizures; or swelling of face, lips, tongue, or throat). Note: This is not a comprehensive list of all side effects. Patient should consult prescriber for additional questions.
Intended Use and Disclaimer: Should not be printed and given to patients. This information is intended to serve as a concise initial reference for health care professionals to use when discussing medications with a patient. You must ultimately rely on your own discretion, experience, and judgment in diagnosing, treating, and advising patients.
