Sodium Lactate (Monograph)

Drug class: Alkalinizing Agents
VA class: TN102
CAS number: 72-17-3

Medically reviewed by Drugs.com on Dec 23, 2024. Written by ASHP.

Introduction

Sodium lactate is an alkalinizing agent.

Uses for Sodium Lactate

Sodium lactate injection is used as a source of bicarbonate in the prevention and treatment of mild to moderate metabolic acidosis in patients whose oral intake is restricted and whose oxidative processes are intact. Because the production of bicarbonate from lactate is delayed for at least 1–2 hours after administration of sodium lactate injection, the drug should not be used in the treatment of severe acidosis that requires immediate correction of plasma bicarbonate concentrations. Sodium lactate should not be used in the treatment of lactic acidosis, since the drug provides no advantage over sodium bicarbonate and may have detrimental effects.

Sodium Lactate Dosage and Administration

Administration

(1/6) M Sodium lactate injection is administered by IV infusion. Sodium lactate solution has also been administered orally. For IV infusion, the rate of infusion of the (1/6) M injection should not exceed 300 mL/hour in adults.

Dosage

Dosage of sodium lactate injection is determined by the severity of the acidosis, appropriate laboratory determinations, and the patient’s age, weight, and clinical condition. Frequent laboratory determinations and clinical evaluation are essential during therapy with sodium lactate, especially during prolonged therapy, to monitor changes in blood glucose and electrolyte concentrations and in fluid and electrolyte and acid-base balance. Fluid administration should be individually based on calculated maintenance or replacement fluid requirements.

The following formula has been suggested as a guide for determining sodium lactate dosage:

Dose in mL of (1/6) M = (60 - plasma CO₂) × (0.8 × body weight in pounds)

For alkalinizing the urine, (1/6) M sodium lactate solution has been administered orally in a dosage of 30 mL/kg daily, given in divided doses.

Cautions for Sodium Lactate

Adverse Effects

Reactions that may occur because of the solution (e.g., from contamination) or administration technique include fever, infection at the site of injection, venous thrombosis or phlebitis extending from the site of injection, and extravasation. Hypervolemia; hypernatremia, with or without edema; or symptoms resulting from an excess or deficit of one or more ions present in the solution may also occur. Aggressive administration of sodium lactate may result in metabolic alkalosis. If an adverse effect occurs during administration of sodium lactate injection, the infusion should be discontinued, the patient evaluated, appropriate therapeutic measures instituted if necessary, and the remainder of the fluid saved for examination if necessary.

Precautions and Contraindications

Changes in fluid balance, electrolyte concentrations, and acid-base balance should be evaluated clinically and via periodic laboratory determinations during prolonged therapy with sodium lactate and in patients whose condition warrants such evaluation. Substantial changes may require additional electrolyte supplements or other appropriate therapy. Additional electrolyte supplementation may also be required in patients with substantial electrolyte losses resulting from conditions such as protracted nasogastric suctioning, vomiting, diarrhea, or GI fistula drainage. Acid-base balance should be carefully monitored to avoid lactate-induced metabolic alkalosis.

Sodium lactate should be used with extreme caution, if at all, in patients with congestive heart failure or other edematous or sodium-retaining conditions, in patients with oliguria or anuria, and in patients receiving corticosteroids or corticotropin, since each gram of sodium lactate contains about 8.9 mEq of sodium. IV administration of sodium lactate may cause fluid and/or solute overload resulting in dilution of serum electrolytes, overhydration, congestive conditions, or pulmonary edema. The risk of dilutional conditions is inversely proportional to the electrolyte concentration administered, and the risk of solute overload and resultant congestive conditions with peripheral and/or pulmonary edema is directly proportional to the electrolyte concentration administered. The manufacturers warn that excessive IV administration of sodium lactate may result in hypokalemia.

Sodium lactate should be administered with extreme caution, if at all, in patients with metabolic or respiratory alkalosis. The drug also should be administered with extreme caution, if at all, in patients with conditions in which there is an increased level or impaired utilization of lactate ion, such as patients with severe hepatic insufficiency, shock, congestive heart failure, hypoxia, or beriberi. Sodium lactate generally is contraindicated in patients with hypernatremia or with conditions in which administration of sodium is detrimental. Sodium lactate should not be used in the treatment of lactic acidosis.

Pregnancy

Pregnancy

Animal reproduction studies have not been performed with sodium lactate. It also is not known whether sodium lactate can cause fetal harm when administered to pregnant women. Sodium lactate should be used during pregnancy only when clearly needed.

Pharmacology

Sodium lactate is an alkalinizing agent whose activity depends on conversion to bicarbonate. Sodium lactate is oxidized in the liver to bicarbonate and glycogen. Lactate is slowly metabolized to carbon dioxide and water, accepting one hydrogen ion and resulting in formation of bicarbonate for the lactate consumed. These reactions depend on cellular oxidative activity. When oxidative activity is intact, conversion of sodium lactate to bicarbonate requires about 1–2 hours. Sodium lactate provides a source of bicarbonate when normal production and utilization of lactic acid is not impaired because of disordered lactate metabolism. The conversion of lactate to bicarbonate is markedly delayed in the presence of tissue anoxia and when the capacity of the liver to metabolize lactate is reduced. This may occur in patients with metabolic acidosis associated with circulatory insufficiency, extracorporeal circulation, hypothermia, glycogen storage disease, liver dysfunction, respiratory alkalosis, shock, cardiac decompensation, or other disorders involving reduced perfusion of body tissues.

Chemistry and Stability

Chemistry

Sodium lactate is an alkalinizing agent. Sodium lactate is a racemic salt; the l-isomer is oxidized in the liver to bicarbonate and the d-isomer is converted to glycogen.

Sodium lactate solution is an aqueous solution containing not less than 50% w/w of monosodium lactate. The solution occurs as a clear, colorless or practically colorless, slightly viscous liquid that has a slight, not unpleasant odor. Sodium lactate solution is miscible with water. The solution has a pH of 5–9. Sodium lactate solution is used in the preparation of sodium lactate injection and lactated Ringer’s injection.

Sodium lactate injection is a sterile sodium lactate solution in water for injection, or a sterile solution of lactic acid in water for injection prepared with the aid of sodium hydroxide. Lactic acid, sodium hydroxide, or hydrochloric acid may be added during the manufacture of the injection to adjust the pH to 6–7.3. Sodium lactate is also available as a small volume parenteral additive solution which provides 5.6 g of sodium lactate and 50 mEq each of sodium and lactate ions per 20 mL; diluting 50 mEq of sodium lactate to 300 mL with a nonelectrolyte solution or sterile water for injection results in a (1/6) M (approximately isotonic) sodium lactate (1.9%) solution. One-sixth molar ((1/6) M) sodium lactate (1.9%) contains approximately 18.7 g/L or about 167 mEq of sodium and 167 mEq of lactate ions per liter, and about 55 calories/L. (1/6) M Sodium lactate injection has a calculated osmolarity of about 330 mOsm/L. Each liter of (1/6) M sodium lactate solution is potentially equivalent in acid-neutralizing effect to 340 mL of a 5% sodium bicarbonate solution.

Stability

Sodium lactate injection should be stored at a temperature of 40°C or less; the injection should be protected from freezing and extreme heat. Specialized references should be consulted for specific compatibility information about sodium lactate injection.

Preparations

Excipients in commercially available drug preparations may have clinically important effects in some individuals; consult specific product labeling for details.

Please refer to the ASHP Drug Shortages Resource Center for information on shortages of one or more of these preparations.

* available from one or more manufacturer, distributor, and/or repackager by generic (nonproprietary) name

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