Vital drug runs low though base ingredient is baking soda

Last shortage of sodium bicarbonate occurred in 2012

Hospitals around the country are scrambling to stockpile vials of a critical drug — even postponing operations or putting off chemotherapy treatments — because the country’s only two suppliers have run out.

The medicine? Sodium bicarbonate solution. Yes, baking soda.

Sodium bicarbonate is the simplest of drugs — its base ingredient, after all, is found in most kitchen cabinets — but it is vitally important for all kinds of patients whose blood has become too acidic. It is found on emergency crash carts and is used in open-heart surgery and as an antidote to certain poisons. Patients whose organs are failing are given the drug, and it is used in some types of chemotherapy. A little sodium bicarbonate can even take the sting out of getting stitches.

“As I talk to colleagues around the country, this is really a problem we’re all struggling with right now,” said Mark Sullivan, head of pharmacy operations at Vanderbilt University Hospital and Clinics in Nashville, Tenn.

Hospitals have been struggling with a dwindling supply of the medicine for months — one of the suppliers, Pfizer, has said that it had a problem with an outside supplier but that the situation worsened a few weeks ago. Pfizer and the other manufacturer, Amphastar, have said they do not know precisely when the problem will be fixed, but it will not be before June for some forms of the drug, and in August or later for other formulations.

Without an abundant supply of sodium bicarbonate, some hospitals are postponing elective procedures or making difficult decisions about which patients merit the drug. At Providence Hospital in Mobile, Ala., supplies ran so low a few weeks ago that Gino Agnelly, the head pharmacist, embarked on a desperate scavenger hunt, culling vials from the 50 crash carts that were stowed around the hospital.

Pfizer sent an emergency shipment a few days later, but the continuing shortage has forced Agnelly to make hard choices.

Erin Fox, a drug shortage expert at the University of Utah, said unexpected shortfalls of critical medicines had become routine. In 2014, a shortage of saline solution — salt water — sent hospitals into a similar panic. This is not even the first time that the supply of sodium bicarbonate has run out. The last shortage occurred in 2012.

“It is unbelievably frustrating,” Fox said. “It makes me so mad that we are out of these really basic lifesaving medications.”

Sullivan, of Vanderbilt, said the shortages typically occurred with cheaper, “bread-and-butter” hospital drugs, leading him to question whether manufacturers were investing enough in the production process needed to make a reliable supply. “The specialty, highdollar medicines — I don’t ever seem to see them experiencing shortages with those products,” he said.