(1343) Sodium Acetate Versus Sodium Bicarbonate in Liver Dysfunction Patients With Acidemia

Introduction: Limited guidance exists for using intravenous sodium acetate (SA) versus sodium bicarbonate (SB) in patients who have acidemia with liver dysfunction at baseline. The efficacy of SA in patients with liver dysfunction has been questioned, as SA is believed to be primarily converted to bicarbonate via hepatic mechanisms. This study aims to evaluate the efficacy of SA verses SB in managing acidemia in liver dysfunction patients.

Methods: This was a multicenter, retrospective chart review study evaluating patients who received SB from September 2019 - February 2020 and SA from September 2020 - February 2021. Included patients had acidemia (serum pH < 7.35 or bicarbonate level < 20 mmol/L), received SB or SA infusion >24 hours, and liver dysfunction (alanine transaminase or aspartate transaminase >99 U/L). The primary outcome was change in serum bicarbonate at baseline at 24 hours post-infusion. Secondary endpoints included hospital length of stay, in-hospital mortality, change in serum bicarbonate, and change in pH at 24, 48, 72, 96, 120, 144, and 168 hours.

Results: Of the 159 patients included, 91 (57.2%) patients received SB and 68 (42.8%) patients received SA. Baseline demographics were similar between each group. There were no differences in duration of infusion (SB, 41.7 [31.2-56.4] hours vs. SA, 42.2 [34.1-52.4] hours, p=0.75) and total mEq of base administered (SB, 710.1 [472.9-1106.9] mEq vs. SA, 622.5 [388.0-1159.9] mEq, p=0.47). Serum bicarbonate levels at 24 hours (SB, 18.0 [15.0-20.0] mEq/L vs. SA, 19.0 [16.0-21.0] mEq/L, p=0.14) and change in serum bicarbonate at 24-hour from baseline (SB, 5 [2.0-8.0] mEq/L vs. SA, 5.0 [3.0-7.0] mEq/L, p=0.61) were not statistically different. For secondary outcomes, there was no difference in hospital length of stay (SB, 9.0 [4.2-18.8] days vs. SA, 10.2 [4.1-19.9] days p=0.97) and in-hospital mortality (SB, 10.0 [11.0%] vs. SA, 9.0 [13.2%] p=0.85). There were no statistically significant differences in other secondary endpoints except for serum bicarbonate values at 96, 120, 144 and 168 hours.

Conclusions: Results of this study suggest SA may be an appropriate alternative to SB for management of acidemia in liver dysfunction patients. Larger studies are needed to confirm these findings.