Sodium Acetate as an Alkalinizing Agent for Salicylate Intoxication: A Case Report

Abstract

Background: Urine and serum alkalization with sodium bicarbonate (NaHCO3) is the initial treatment for salicylate toxicity. Due to medication shortages, sufficient quantities of NaHCO3 may not be available and alternative treatments may be needed. Case Report: This is an observational case report of a man who presented with chronic, inadvertent aspirin intoxication. Initially, we used a NaHCO3 continuous intravenous (IV) infusion until the hospital ran out of NaHCO3. Thereafter, the NaHCO3 IV infusion was replaced with a sodium acetate (SA) continuous IV infusion. “Why should an emergency physician be aware of this?” Sodium acetate’s role in serum and urine alkalization for drug intoxications is not well understood. Physiologically, SA is converted to acetyl-coA and processed through the Krebs cycle, producing CO2 and later bicarbonate via carbonic anhydrase. In severe salicylism, key enzymes of the Krebs cycle are inhibited, ultimately forming lactate and preventing the conversion of SA to bicarbonate. We hypothesize that in our patient, the Krebs cycle continued to function as evidenced by the normal lactate level, suggesting a mild to moderate degree of chronic salicylate toxicity. At such levels, SA appears to be an effective means of serum and urine alkalization.