Version July 2025
Note: Sodium acetate is metabolized to bicarbonate on an equimolar basis outside the liver; administer in large volume IV fluids as a sodium source. Refer to Sodium Bicarbonate monograph.
Maintenance electrolyte requirements of sodium in parenteral nutrition solutions:
Acetate maintenance electrolyte requirement: IV: Acetate and chloride content should be adjusted to maintain acid-base balance with parenteral nutrition; use equal amounts of acetate and chloride and adjust ratio based on individual patient needs (Ref).
Sodium maintenance electrolyte requirement (combination of chloride and acetate, where applicable): IV: 1 to 2 mEq/kg/24 hours; customize amounts based on individual patient needs (Ref). General maximum sodium acetate: 100 to 150 mEq/24 hours.
No dosage adjustment provided in manufacturer’s labeling. Use with caution.
No dosage adjustment provided in manufacturer’s labeling. Use with caution.
Refer to adult dosing.
(For additional information see "Sodium acetate: Pediatric drug information")
Note : Maintenance sodium should be incorporated into the patient's maintenance IV fluids; acid/base balance should be considered when selecting a sodium salt; acetate is converted to bicarbonate on an equimolar basis within the body and may affect serum pH.
Parenteral nutrition, maintenance sodium requirement: Note: A combination of salt forms may be necessary to fulfill sodium requirement (Ref).
Infants and Children ≤50 kg: IV: 2 to 5 mEq/kg/day of sodium as an additive to parenteral nutrition solution.
Children >50 kg and Adolescents: IV: 1 to 2 mEq/kg/day of sodium as an additive to parenteral nutrition solution.
Metabolic acidosis: Limited data available: Infants, Children, and Adolescents: Each mEq of acetate is converted 1:1 to mEq of bicarbonate (HCO3 -); dosage should be based on standard dosing formulas if blood gases and pH measurements are available. Refer to the Sodium Bicarbonate monograph for specific dosing details and equations.
There are no dosage adjustments provided in manufacturer’s labeling. Use with caution.
There are no dosage adjustments provided in manufacturer’s labeling. Use with caution.
The following adverse drug reactions and incidences are derived from product labeling unless otherwise specified.
1% to 10%:
Cardiovascular: Localized phlebitis, thrombosis
Endocrine & metabolic: Electrolyte disturbance (dilution of serum electrolytes), hypernatremia, hypervolemia, hypocalcemia, hypokalemia, metabolic alkalosis, water intoxication
Gastrointestinal: Abdominal distention, flatulence
Respiratory: Pulmonary edema
Hypernatremia and fluid retention
Concerns related to adverse effects:
• Hypernatremia: Close monitoring of serum sodium concentrations is needed to avoid hypernatremia.
Disease-related concerns:
• Acid/base disorders: Use with caution in patients with acid/base alterations; contains acetate, monitor closely during acid/base correction.
• Edema: Use with caution in edematous patients.
• Heart failure (HF): Use extreme caution in patients with HF; monitor closely for edema.
• Hepatic impairment: Use with caution in patients with severe hepatic impairment.
• Renal impairment: Use with caution in patients with renal impairment; monitor serum sodium concentrations closely.
Dosage form specific issues:
• Aluminum: The parenteral product may contain aluminum; toxic aluminum concentrations may be seen with high doses, prolonged use, or renal dysfunction. Premature neonates are at higher risk due to immature renal function and aluminum intake from other parenteral sources. Parenteral aluminum exposure of >4 to 5 mcg/kg/day is associated with CNS and bone toxicity; tissue loading may occur at lower doses (Federal Register, 2002). See manufacturer’s labeling.
Other warnings/precautions:
• Extravasation: Avoid extravasation.
Excipient information presented when available (limited, particularly for generics); consult specific product labeling. [DSC] = Discontinued product
Solution, Intravenous, as anhydrous:
Generic: 2 mEq/mL (20 mL, 50 mL, 100 mL); 4 mEq/mL (50 mL [DSC], 100 mL)
Solution, Intravenous, as anhydrous [preservative free]:
Generic: 2 mEq/mL (20 mL, 50 mL, 100 mL); 4 mEq/mL (100 mL)
Yes
Solution (Sodium Acetate Intravenous)
2 mEq/mL (per mL): $0.19 - $0.75
4 mEq/mL (per mL): $0.11 - $0.41
Disclaimer: A representative AWP (Average Wholesale Price) price or price range is provided as reference price only. A range is provided when more than one manufacturer's AWP price is available and uses the low and high price reported by the manufacturers to determine the range. The pricing data should be used for benchmarking purposes only, and as such should not be used alone to set or adjudicate any prices for reimbursement or purchasing functions or considered to be an exact price for a single product and/or manufacturer. Medi-Span expressly disclaims all warranties of any kind or nature, whether express or implied, and assumes no liability with respect to accuracy of price or price range data published in its solutions. In no event shall Medi-Span be liable for special, indirect, incidental, or consequential damages arising from use of price or price range data. Pricing data is updated monthly.
Excipient information presented when available (limited, particularly for generics); consult specific product labeling.
Solution, Intravenous, as anhydrous:
Generic: 4 mEq/mL (50 mL, 100 mL)
IV: Must be diluted prior to IV administration; infuse hypertonic solutions (eg, >2.8% sodium acetate in sterile water [2.8% sodium acetate in sterile water has osmolarity approximately equivalent to 2% sodium chloride]) via a central line (Ref). If diluted in D5W or other solution, the osmolarity may be higher requiring central line administration at a lower sodium acetate concentration.
Consult individual institutional policies and procedures.
Parenteral: Must be diluted prior to IV administration; dose and rate of administration are dependent on patient condition. Consult individual institutional policies and procedures; in general, central-line administration is preferred for hypertonic solutions (>0.9%) if available and/or if infusion is to be continued; peripheral administration may be necessary for initiation of treatment in critical patients; use of peripheral administration should be limited (Ref). Some suggest central line administration is not needed until infusing solutions >2.8% sodium acetate in sterile water (2.8% sodium acetate in sterile water has osmolarity approximately equivalent to 2% sodium chloride) (Ref). If diluted in D5W or other solution, the osmolarity may be higher requiring central line administration at a lower sodium acetate concentration.
Sodium source in large volume IV fluids to prevent or correct hyponatremia in patients with restricted intake; used to counter acidosis through conversion to bicarbonate
Sodium acetate may be confused with potassium acetate
None known.
Note: Interacting drugs may not be individually listed below if they are part of a group interaction (eg, individual drugs within “CYP3A4 Inducers [Strong]” are NOT listed). For a complete list of drug interactions by individual drug name and detailed management recommendations, use the drug interactions program by clicking on the “Launch drug interactions program” link above.
Amantadine: Alkalinizing Agents may increase serum concentration of Amantadine. Risk C: Monitor
Amphetamines: Alkalinizing Agents may decrease excretion of Amphetamines. Management: Consider alternatives to using amphetamines and alkalinizing agents in combination. If these agents must be used together, patients should be monitored closely for excessive amphetamine effects. Risk D: Consider Therapy Modification
Flecainide: Alkalinizing Agents may decrease excretion of Flecainide. Risk C: Monitor
Mecamylamine: Alkalinizing Agents may increase serum concentration of Mecamylamine. Risk C: Monitor
Memantine: Alkalinizing Agents may increase serum concentration of Memantine. Risk C: Monitor
QuiNIDine: Alkalinizing Agents may increase serum concentration of QuiNIDine. Risk C: Monitor
QuiNINE: Alkalinizing Agents may increase serum concentration of QuiNINE. Risk C: Monitor
Animal reproduction studies have not been conducted. Sodium requirements do not change during pregnancy (IOM, 2004).
Sodium is found in breast milk. Sodium requirements do not change during lactation (IOM, 2004).
Sodium acetate anhydrous (2 mEq/mL): 1 mL = 164 mg sodium acetate anhydrous = 2 mEq of sodium (46 mg) and acetate (118 mg)
Serum electrolytes, including sodium, calcium, serum pH.
