Overview:
A prescription drug called Sodium lactate is used to treat or avoid mild to severe metabolic acidosis. It functions by giving the liver a supply of lactate, which it may then convert into bicarbonate. The Food and Drug Administration revision date for Sodium lactate is 8th August 2001. In situations of acidosis, bicarbonate helps elevate the pH of the blood and acts as a buffer. However, it is not useful in cases of severe acidosis. It may be harmful in cases of lactic acidosis, a condition when excessive lactate levels already exist.
Drug Group:
Sodium lactate is a member of the class of medications known as alkalinizing agents, which are also known as electrolyte replenishers.
Available Doses and Dosage Forms:
Usually, sterile, concentrated Sodium lactate solution is sold exclusively for intravenous (IV) use.
Depending on the manufacturer, the precise concentration (amount of Sodium lactate per milliliter) may change. Five mEq/mL (milliequivalent) is a typical concentration.
A doctor bases the Sodium lactate dose on several variables, such as:
-
The degree of acidity.
-
Underlying reason.
-
The unique demands of each patient.
For Patients:
What Is Metabolic Acidosis?
A condition known as metabolic acidosis occurs when the body either loses too much bicarbonate or collects too much acid, which lowers blood pH (acidity). A normal blood pH ranges from 7.35 to 7.45, which is somewhat basic. The pH falls below this range in metabolic acidosis.
The following are a few common causes of metabolic acidosis:
-
Increased Acid Production: This can be brought on by diseases such as lactic acidosis from intense activity or oxygen deprivation, diabetic ketoacidosis (production of toxic byproducts like ketones released due to insulin deficiency), and alcoholic ketoacidosis (ketone levels increase in the plasma due to extensive alcohol use).
-
Reduced Loss of Bicarbonate: Normally, the kidneys help control blood pH by eliminating excess acid. This function may be compromised by kidney illness or certain medicines.
-
Bicarbonate Loss: The body may lose bicarbonate as a result of severe diarrhea or vomiting.
Symptoms of metabolic acidosis can vary depending on the severity but may include:
-
Rapid breathing.
-
Fatigue.
-
Nausea and vomiting.
-
Confusion.
-
Shortness of breath.
-
Coma (in severe cases).
How Does Sodium Lactate Work?
Sodium lactate functions by restoring the body's electrolyte and salt balance. There are two ways that Sodium lactate can aid with mild to severe metabolic acidosis:
-
Bicarbonate Precursor: The liver may transform the lactate component of Sodium lactate into bicarbonate. In the blood, bicarbonate functions as a buffer to assist in raising blood pH and balance out excess acid.
-
Energy Source: Glycogen, a type of stored energy, can also be produced by the liver from lactate. In certain circumstances, this may be advantageous if the body requires more energy.
What Is the Dosage of Sodium Lactate?
A doctor with experience in intravenous fluid treatment should decide on the product, dose, volume, pace, and length of administration based on the patient's age, weight, and clinical state, as well as any concurrent therapies.
How Effective Is Sodium Lactate?
A useful therapy for mild to severe metabolic acidosis is Sodium lactate. This is an analysis of its efficacy:
Advantages:
-
Offers a means of producing bicarbonate, which elevates pH and functions as a blood buffer.
-
The lactate component may occasionally be transformed into glycogen for energy.
Disadvantages:
-
Ineffective in cases of severe acidosis. Perhaps more aggressive therapy is required.
-
It may exacerbate chronic hyper lactate conditions, such as lactic acidosis.
-
It is not suitable as a first-line therapy for all forms of acidosis.
All things considered, Sodium lactate can be a useful tool, but it should only be administered under medical supervision and when the acidosis's underlying etiology is well understood.
What Are the Things to Inform the Doctor Before Taking the Sodium Lactate?
Before using Sodium lactate, it is important to let the doctor know about:
-
Any past medical issues, particularly those related to renal illness, cardiac issues, or fluid retention.
-
All prescription, over-the-counter, and herbal supplement drugs that are presently used.
-
Anything that leads to becoming allergic, especially to drugs or preservatives.
-
Pregnancy or nursing as the doctor assesses the possible hazards and advantages of using Sodium lactate during pregnancy or breastfeeding.
How Is Sodium Lactate Administered?
-
The intravenous delivery of Sodium lactate is meant to be done with sterile equipment. It requires diluting.
-
To prevent air embolism from potentially leftover air in the primary container, do not link flexible plastic containers in series.
-
To avoid air embolism, turn the vent on a vented intravenous administration to the closed position.
-
To prevent air embolism from the incomplete evacuation of residual air in the container, do not pressurize intravenous fluids stored in flexible plastic containers to boost flow rates.
-
Visually check the solution for discoloration and particles before infusion. If the solution is opaque and the container is intact, do not administer.
-
Because Sodium lactate's calcium concentration increases the risk of coagulation, it is not recommended to infuse Sodium lactate and citrate into anticoagulated or preserved blood through the same administration set.
What Are the Side Effects of Sodium Lactate?
-
Common adverse effects include headaches, nausea, vomiting, warmth in the abdomen, pain, and reactions at the injection site (pain, swelling, redness).
-
Severe adverse effects (less frequent) include seizures (sudden surge of uncontrolled movements due to neuronal activity), rapid breathing, disorientation, weakness in the muscles, and fluid overload (especially if having underlying renal issues).
Dietary Considerations:
Dietary limitations do not apply to Sodium lactate per se. However, dietary adjustments may be necessary according to the underlying cause of metabolic acidosis. For example, a low-carb diet may be advised in cases of diabetic ketoacidosis.
Missed Dose:
A healthcare provider usually delivers Sodium lactate in a hospital environment. In the few instances where it could be administered at home under certain instructions, missing a dose may occur. In such cases, never take two doses to make up for one that was missed.
To find out how to continue, speak with the doctor.
Overdose:
-
When Sodium lactate is administered excessively, it can result in hyperkalemia (high potassium) and hypernatremia (high sodium levels), particularly in those with severe renal impairment.
-
Excessive fluid intake may result in peripheral or pulmonary edema.
-
Hypokalemia with or without metabolic alkalosis.
-
Bicarbonate loss has an acidifying impact.
-
An excess of calcium.
If one consumes too much Sodium lactate, get professional help right away.
Storage
Usually, Sodium lactate is manufactured and kept in a medical environment. But if having any diluted Sodium lactate solution left over for use:
-
It may need to be refrigerated; follow the doctor's recommendations for storage.
-
Never use diluted solutions left over from a prior treatment.
-
If a solution is no longer needed or has expired, dispose of it according to the doctor's instructions or, if appropriate, the hazardous waste disposal rules.
For Doctors:
Indication:
Sodium lactate is primarily used to treat or prevent mild to severe metabolic acidosis in individuals with limited oral intake who have compromised acid elimination capacity.
Dose:
Sodium lactate does not have a single "standard" dosage. A physician will choose the right dosage depending on several variables, including:
-
Acidosis Severity: More severe cases could require greater dosages or alternative treatment modalities.
-
Root Cause: The particular cause of acidosis will determine the course of treatment and maybe the right dosage of Sodium lactate.
-
Patient’s Individual Needs: Determining a safe and effective dosage requires consideration of several factors, including age, weight, renal function, and general health state.
The standard concentration of the Sodium lactate solution is 5 mEq/mL (milliequivalents per milliliter).
Dosing Considerations:
The following factors affect a doctor's decision on the right dosage of Sodium lactate:
-
Blood pH and Electrolyte Levels: These laboratory tests aid in determining the degree of acidosis and direct the course of treatment.
-
Acidosis Cause: The underlying cause of acidosis will determine the specific treatment approach, which will include Sodium lactate dosage and use.
-
Renal Function of the Patient: Since the kidneys remove Sodium lactate, a decrease in renal function may need dosage modifications or other therapeutic strategies.
-
Fluid Status: When deciding on how much diluted solution to give to a patient, the doctor will take into account their level of hydration as well as their risk of fluid overload.
What Are the Pharmacological Aspects of Sodium Lactate?
-
Pharmacodynamics:
Sodium lactate's lactate component serves as a prodrug for bicarbonate. Lactate is absorbed by the liver and transformed into pyruvate. After that, pyruvate can be changed into bicarbonate, which helps elevate blood pH in metabolic acidosis and buffer excess acid in the blood.
-
Limited Direct Effect: Blood pH is not immediately raised by Sodium lactate on its own. Its conversion to bicarbonate, which has a buffering effect, is what makes it beneficial.
-
Mechanism:
There are many phases in the mechanism of action:
-
Intravenous Administration: Lactate is injected straight into the circulation via an intravenous line to give Sodium lactate.
-
Liver Uptake: Lactate is taken up by the liver cells from the blood.
-
Lactate Metabolism: Pyruvate is produced from lactate by liver cell enzymes.
-
Production of Bicarbonate: Pyruvate can then be transformed via a metabolic route into bicarbonate.
-
Blood pH Buffering: By neutralizing excess acid in the blood, the newly produced bicarbonate raises blood pH and lessens the consequences of metabolic acidosis.
-
Pharmacokinetics:
-
Absorption: Since Sodium lactate is injected intravenously, intestinal absorption is not necessary because it is easily absorbed into the circulation.
-
Distribution: Lactate is found in all bodily fluids, although it is especially found in the liver, where it is converted to bicarbonate.
-
Metabolism: The liver is the main site of metabolism, where lactate is changed into pyruvate and maybe bicarbonate.
-
Excretion: As part of regular acid-base balance, the body predominantly gets rid of lactate by converting it to bicarbonate, which is subsequently expelled by the kidneys. For energy, some lactate may also be transformed into glucose or glycogen.
Toxicity:
If Sodium lactate is not utilized correctly, it might be harmful. The following is a summary of possible toxicity issues:
-
Overdosage: Breathing quickly, confusion, weakening of the muscles, seizures, overindulgence in fluids (especially when there are underlying renal issues).
-
Fast Administration: If Sodium lactate is infused too quickly, certain adverse effects may get worse.
-
Lactic Acidosis: The body's capacity to handle lactate can be overloaded by Sodium lactate injection in situations of lactic acidosis, where lactate levels are already elevated, potentially making the condition worse.
Clinical Studies:
The use of Sodium lactate for metabolic acidosis has been the subject of several clinical investigations. The following are some broad highlights of the Sodium lactate research:
-
Its use in mild to severe metabolic acidosis when other therapies are not appropriate is supported by studies.
-
Additionally, the research emphasizes how crucial it is to watch closely throughout the administration to prevent problems.
-
Research is being conducted to investigate the efficacy of Sodium lactate in several therapeutic contexts.
What Are the Contraindications of Sodium Lactate?
-
Sodium lactate should not be administered to newborns (less than 28 days of age) receiving Ceftriaxone concurrently, even if separate infusion lines are utilized, since there is a danger of Ceftriaxone-calcium salt precipitation in the neonate's circulation that can be deadly.
-
Individuals receiving Ceftriaxone concurrently through the same infusion line (for example, via a Y-connector) who are older than 28 days. The infusion line must be completely cleansed with a compatible fluid in between infusions if it is being used for consecutive administration.
-
Individuals who have a history of Sodium lactate hypersensitivity.
-
In severe metabolic acidosis, it usually requires more intensive treatment.
-
In lactic acidosis, Sodium lactate has been shown to exacerbate lactic acidosis.
-
Hypernatremia is a condition characterized by elevated blood salt levels. Sodium lactate may be a factor in this issue.
-
Renal impairment, as the usage of Sodium lactate, can be complicated by poor renal function since the body excretes lactate by first turning it into bicarbonate and then excreting it through the kidneys.
Warnings and Precautions:
The main concerns with Sodium lactate are the possibility of electrolyte imbalances and fluid excess when using the product. Below is a summary of the main ideas:
-
Potassium: Insufficient potassium in Sodium lactate injection renders it ineffective in treating severe insufficiency. It can also raise potassium levels in certain people at risk.
-
Sodium: Especially in individuals who are at high risk, be aware of any possible hyponatremia or low sodium. It might be risky to treat hyponatremia quickly.
-
Fluid Overload: Patients who are already at risk for edema or fluid overload should not receive Sodium lactate injection. Keep a careful eye on the fluid equilibrium.
-
Metabolic Alkalosis: Lactate can exacerbate pre-existing metabolic alkalosis.
-
Additional Information: In certain instances, the injection may result in hyperglycemia (high blood sugar) and hypercalcemia (high calcium).
-
Monitoring: Keep a careful eye on fluid status, electrolytes, and acid-base balance, particularly in individuals who pose a high risk.
What Are the Drug Interactions of Sodium Lactate?
Certain drugs may interact with Sodium lactate, perhaps reducing their efficacy or raising the possibility of adverse consequences.
Interactions Between Drugs:
-
Diuretics: When used with Sodium lactate, medications that cause an increase in urine production (diuretics) might exacerbate the risk of electrolyte imbalances, especially potassium loss.
-
Corticosteroids: When combined with Sodium lactate, these drugs may increase fluid and salt retention, which may raise the risk of fluid overload.
-
Antidepressants: When taken with Sodium lactate, several antidepressants, such as selective serotonin reuptake inhibitors (SSRIs), may raise the risk of hyponatremia or low sodium.
-
Antiepileptic Drugs: It is important to exercise caution while using antiepileptic drugs together with Sodium lactate since they can increase the risk of hyponatremia.
-
Diuretics That Spare Potassium: These diuretics might result in hyperkalemia or elevated potassium, and taking them together with Sodium lactate may cause potassium levels to rise even more.
-
Lithium: Sodium lactate may have an impact on the kidneys' ability to excrete lithium, which may affect blood lithium levels.
Specific Considerations:
-
Pregnancy: Sodium lactate should be used with caution in pregnant women, as pregnant women have not been the subject of any safety investigations. If Sodium lactate affects fertility or causes damage to the fetus, this is unclear. Sodium lactate should only be administered if required during pregnancy.
-
Breastfeeding: Breastfeeding moms are urged to use caution as it is uncertain if Sodium lactate enters breast milk.
-
Pediatric: Although sufficient and well-regulated studies have not been conducted to determine the safety and efficacy of Sodium lactate injection, USP (United States Pharmacopeia) in pediatric patients, the usage of electrolyte solutions in this age group is mentioned in the medical literature. The pediatric population should be aware of the cautions, warnings, and adverse reactions included in the label wording. When administering an intravenous solution containing lactate to newborns, it is important to consider that their liver and kidneys are still developing throughout the first year of life. This development also influences the biotransformation and renal excretion of lactate.
-
Geriatric Patients: Electrolyte imbalances are more likely to occur in elderly persons. Because Sodium lactate is known to be heavily excreted by the kidney, individuals who already have renal impairment may be more susceptible to adverse effects from this medication. Because reduced hepatic, renal, or cardiac function, as well as concurrent diseases or other medication therapy, are more common in older patients, dosage selection should be conservative, often beginning at the low end of the dosing range. It is important to examine older individuals' renal function.
