What keeps emergency physicians up at night? It could be something as seemingly innocuous as baking soda. As Katie Thomas reports for The New York Times, a shortage of a simple drug—an injectable form of baking soda—is ballooning into a big problem for hospitals.
Baking soda might be hanging out in your refrigerator or awaiting your next batch of pancakes, but for patients in cardiac arrest, undergoing heart surgery or receiving chemotherapy, it’s a vital injectable drug. It’s used to treat acidosis (which happens when the body’s fluids become too acidic), to help stabilize failing organs, and as an antidote to overdoses of some drugs like tricyclic antidepressants. It acts on internal fluids much the same as it does on your upset stomach, taking acid levels down.
Though it seems like keeping a solution of what amounts to a common kitchen ingredient in stock would be easy. But it isn't. According to the American Society of Health-System Pharmacists, a nationwide shortage of the drug is driven by both increased demand and manufacturing delays. The United States only has two manufacturers of sterile sodium bicarbonate solution: Pfizer and Amphistar. Both are unable to provide the drug at this time.
The shortage is prompting hospitals to make some hard decisions, reports Thomas, as they grapple with who needs the drug more—including one hospital that postponed seven open-heart surgeries because one patient needed a large quantity of the drug.
Drug shortages are nothing new in hospitals. According to the FDA, sterile injectable drugs make up a high number of the shortages in the United States, often due to capacity limitations on the manufacturer side. The U.S. is just one of many countries that has faced a shortage of injectable penicillin over the last several years, in part because many manufacturers have simply started producing more profitable drugs instead.
Shortages can have real consequences for patients. As Reuters’ Andrew Seaman reports, a year-long shortage of a drug used to treat septic shock increased the likelihood that patients with the condition would die by almost 4 percent in 2011. Sodium bicarbonate is simple enough, but without a sterile supply, it can’t be used to save lives. It could be months before it makes its way back to hospital shelves—and years before the shortage’s impact on patients is fully understood.