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Luckraz H, Giri R, Wrigley B, Nagarajan K, Senanayake E, Sharman E, Beare L, Nevill A. Balanced forced-diuresis as a renal protective approach in cardiac surgery: Secondary outcomes of electrolyte changes. J Card Surg 2021; 36:4125-4131. [PMID: 34414606 PMCID: PMC9292049 DOI: 10.1111/jocs.15925] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Accepted: 07/18/2021] [Indexed: 12/19/2022]
Abstract
Objectives Forced‐diuresis during cardiopulmonary bypass (CPB) can be associated with significant electrolyte shifts. This study reports on the serum electrolyte changes during balanced forced‐diuresis with the RenalGuard® system (RG) during CPB. Methods Patients at risk of acute kidney injury (AKI)—(history of diabetes &/or anaemia, e‐GFR 20–60 ml/min/1.73 m2, anticipated CPB time >120 min, Log EuroScore >5)—were randomized to either RG (study group) or managed as per current practice (control group). Results The use of RG reduced AKI rate (10% for RG and 20.9% in control, p = .03). Mean urine output was significantly higher in the RG group during surgery (2366 ± 877 ml vs. 765 ± 549 ml, p < .001). The serum potassium levels were maintained between 3.96 and 4.97 mmol/L for the RG group and 4.02 and 5.23 mmol/L for the controls. Median potassium supplemental dose was 60 (0–220) mmol (RG group) as compared to 30 (0–190) mmol for control group over first 24 h (p < .001). On Day 1 post‐op, there were no significant differences in the serum sodium, potassium, calcium, magnesium, phosphate, and chloride levels between the two groups. Otherwise, postoperative clinical recovery was also similar. Conclusions Balanced forced‐diuresis with the RG reduced AKI rates after on‐pump cardiac surgery compared to controls. Although the RG group required higher doses of IV potassium replacement in the postoperative period, normal serum levels of potassium were maintained by appropriate intravenous potassium supplementation and the clinical outcomes between groups were similar.
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Affiliation(s)
- Heyman Luckraz
- Department of Cardiothoracic Surgery, Consultant Cardiothoracic Surgeon, American Hospital, Dubai, UAE
| | - Ramesh Giri
- Department of Cardiothoracic Anaesthesiology, Consultant Cardiothoracic Anaesthesiologist, Heart & Lung Centre, Wolverhampton, UK
| | - Benjamin Wrigley
- Department of Cardiology, Consultant Interventional Cardiologist, Heart & Lung Centre, Wolverhampton, UK
| | - Kumaresan Nagarajan
- Department of Cardiothoracic Surgery, Heart & Lung Centre, Wolverhampton, UK
| | - Eshan Senanayake
- Department of Cardiothoracic Surgery, Heart & Lung Centre, Wolverhampton, UK
| | - Emma Sharman
- Research Nurse, Research & Development Department, Heart & Lung Centre, Wolverhampton, UK
| | - Lawrence Beare
- Department of Cardiothoracic Surgery, Chief Clinical Perfusionist, University Hospitals of North Midlands, Stoke-on-Trent, UK
| | - Alan Nevill
- Department of Statistics, Faculty of Education, Health, and Wellbeing, University of Wolverhampton, Walsall, UK
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Intraoperative Cell Saving: Is the Solution the Actual Problem? THE JOURNAL OF EXTRA-CORPOREAL TECHNOLOGY 2021; 53:62-67. [PMID: 33814608 DOI: 10.1182/ject-2000047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Received: 08/29/2020] [Accepted: 01/28/2021] [Indexed: 11/20/2022]
Abstract
Allogenic blood is a scarce, precious, and expensive resource that is not always available on demand. After termination of cardiopulmonary bypass, a large amount of residual pump blood remains in the extracorporeal circuit. The cell saver washes and concentrates this blood with .9% normal saline (NS), making autologous blood available and reducing the demand for allogenic blood. To quantify the quality of residual pump blood it was washed with either NS or a bicarbonate-buffered solution (Balsol). A qualitative in vitro analysis was conducted. Residual cardiopulmonary bypass blood from forty bypass circuits was processed with a cell saver device, using NS or Balsol solution. Measurements made compared the pH, electrolytes, metabolites, hematocrit, hemoglobin, osmolality, albumin, total protein, and strong ion difference. There were significant differences between the NS and Balsol groups. In the Balsol group, osmolality, electrolytes, and strong ion difference were similar to the constitution of Balsol solution after washing, but not with the normal saline group. Washing residual cardiopulmonary bypass pump blood with Balsol solution results in a resuspended red cell concentrate with a superior electrolyte profile and a strong ion difference similar to that of residual pump blood.
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ABG Assistant-Towards an Understanding of Complex Acid-Base Disorders. J Clin Med 2021; 10:jcm10071516. [PMID: 33916476 PMCID: PMC8038584 DOI: 10.3390/jcm10071516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2021] [Revised: 03/30/2021] [Accepted: 04/02/2021] [Indexed: 11/30/2022] Open
Abstract
The ability to diagnose acid-base imbalances correctly is essential for physicians and other healthcare workers. Despite its importance, it is often considered too complex and confusing. Although most people dealing with arterial blood gases (ABGs) do not usually have problems with acid-base disorder assessment, such an analysis is also carried out by other healthcare workers for whom this can be a challenging task. Many aspects may be problematic, partly due to multiple data analysis methods and no definitive statement on which one is better. According to our survey, the correctness of arterial blood gas analysis is unsatisfactory, especially in mixed disorders, which do not always manifest an obvious set of symptoms. Therefore, ABG parameters can be used as an established biomarker panel, which is considered to be a powerful tool for personalized medicine. Moreover, using different approaches to analyze acid-base disorders can lead to varying diagnoses in some cases. Because of these problems, we developed a mobile application that can spot diagnostic differences by taking into account physiological and chemical approaches, including their variants, with a corrected anion gap. The proposed application is characterized by a high percentage of correct analyses and can be an essential aid for diagnosing acid-base disturbances.
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García-Camacho C, Marín-Paz AJ, Lagares-Franco C, Abellán-Hervás MJ, Sáinz-Otero AM. Continuous ultrafiltration during extracorporeal circulation and its effect on lactatemia: A randomized controlled trial. PLoS One 2020; 15:e0242411. [PMID: 33227001 PMCID: PMC7682870 DOI: 10.1371/journal.pone.0242411] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Accepted: 10/30/2020] [Indexed: 11/19/2022] Open
Abstract
Introduction Hyperlactatemia occurs during or after extracorporeal circulation in the form of lactic acidosis, increasing the risk of postoperative complications and the mortality rate. The aim of this study was to evaluate whether continuous high-volume hemofiltration with volume replacement through a polyethersulfone filter during the extracorporeal circulation procedure decreases postoperative lactatemia and its consequences. Materials and methods This was a randomized controlled trial. Patients were randomly divided into two groups of 32: with or without continuous high-volume hemofiltration through a polyethersulfone membrane. Five patients were excluded from each group during the study period. The sociodemographic characteristics, filter effects, and blood lactate levels at different times during the procedure were evaluated. Secondary endpoints were studied, such as the reduction in the intubation time and time spent in ICU. Results Lactatemia measurements performed during the preoperative and intraoperative phases were not significantly different between the two groups. However, the blood lactate levels in the postoperative period and at 24 hours in the intensive care unit showed a significant reduction and a possible clinical benefit in the hemofiltered group. Following extracorporeal circulation, the mean lactate level was higher (difference: 0.77 mmol/L; CI 0.95: 0.01–1.53) in the nonhemofiltered group than in the hemofiltered group (p<0.05). This effect was greater at 24 hours (p = 0.019) in the nonhemofiltered group (difference: 1.06 mmol/L; CI 0.95: 0.18–1.93) than in the hemofiltered group. The reduction of lactatemia is associated with a reduction of inflammatory mediators and intubation time, with an improvement in liver function. Conclusions The use and control of continuous high-volume hemofiltration through a polyethersulfone membrane during heart-lung surgery could potencially prevent postoperative complications. The reduction of lactatemia implied a reduction in intubation time, a decrease in morbidity and mortality in the intensive care unit and a shorter hospital stay.
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Affiliation(s)
- Carlos García-Camacho
- Cardiovascular Surgery Unit, Puerta del Mar University Hospital, Andalusian Health Service, Cadiz, Andalusia, Spain
| | - Antonio-Jesús Marín-Paz
- Nursing and Physiotherapy Department, Faculty of Nursing, University of Cadiz, Algeciras, Spain
- * E-mail:
| | - Carolina Lagares-Franco
- Department of Statistics and Operative Research, University of Cadiz, Cadiz, Andalusia, Spain
| | - María-José Abellán-Hervás
- Nursing and Physiotherapy Department, Faculty of Nursing and Physiotherapy, University of Cadiz, Cadiz, Spain
| | - Ana-María Sáinz-Otero
- Nursing and Physiotherapy Department, Faculty of Nursing and Physiotherapy, University of Cadiz, Cadiz, Spain
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Weinberg L, Chiam E, Hooper J, Liskaser F, Hawkins AK, Massie D, Ellis A, Tan CO, Story D, Bellomo R. Plasma-Lyte 148 vs. Hartmann's solution for cardiopulmonary bypass pump prime: a prospective double-blind randomized trial. Perfusion 2017; 33:310-319. [PMID: 29144182 DOI: 10.1177/0267659117742479] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
BACKGROUND The mechanisms of acid-base changes during cardiopulmonary bypass (CPB) remain unclear. We tested the hypothesis that, when used as CPB pump prime solutions, Plasma-Lyte 148 (PL) and Hartmann's solution (HS) have differential mechanisms of action in their contribution to acid-base changes. METHODS We performed a prospective, double-blind, randomized trial in adult patients undergoing elective cardiac surgery with CPB. Participants received a CPB prime solution of 2000 mL, with either PL or HS. The primary endpoint was the standard base excess (SBE) value measured at 60 minutes after full CPB flows (SBE60min). Secondary outcomes included changes in SBE, pH, chloride, sodium, lactate, gluconate, acetate, strong ion difference and strong ion gap at two (T2min), five (T5min), ten (T10min), thirty (T30min) and sixty (T60min) minutes on CPB. The primary outcome was measured using a two-tailed Welch's t-test. Repeated measures ANOVA was used to test for differences between time points. RESULTS Twenty-five participants were randomized to PL and 25 to HS. Baseline characteristics, EURO and APACHE scores, biochemistry, hematology and volumes of cardioplegia were similar. Mean (SD) SBE at T60min was -1.3 (1.4) in the PL group and -0.1 (2.7) in the HS group; p=0.55. No significant differences in SBE between the groups was observed during the first 60 minutes (p=0.48). During CPB, there was hyperacetatemia and hypergluconatemia in the PL group and hyperlactatemia and hyperchloremia in the HS group. No significant difference between the groups in plasma bicarbonate levels and total weak acid levels were found. Complications and intensive care unit and hospital length of stays were similar. CONCLUSIONS During CPB, PL and HS did not cause a significant metabolic acidosis. There was hyperacetatemia and hypergluconatemia with PL and hyperchloremia and hyperlactatemia with HS. These physiochemical effects appear clinically innocuous.
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Affiliation(s)
- Laurence Weinberg
- 1 Department of Anesthesia, Austin Health, Heidelberg, Victoria, Australia.,2 Department of Surgery, The University of Melbourne, Austin Health, Victoria, Australia
| | - Elizabeth Chiam
- 2 Department of Surgery, The University of Melbourne, Austin Health, Victoria, Australia
| | - James Hooper
- 1 Department of Anesthesia, Austin Health, Heidelberg, Victoria, Australia
| | - Frank Liskaser
- 1 Department of Anesthesia, Austin Health, Heidelberg, Victoria, Australia
| | - Angela Kim Hawkins
- 1 Department of Anesthesia, Austin Health, Heidelberg, Victoria, Australia
| | - Denise Massie
- 3 Department of Clinical Pharmacology & Therapeutics, Austin Hospital, Heidelberg, Victoria, Australia
| | - Andrew Ellis
- 3 Department of Clinical Pharmacology & Therapeutics, Austin Hospital, Heidelberg, Victoria, Australia
| | - Chong O Tan
- 1 Department of Anesthesia, Austin Health, Heidelberg, Victoria, Australia
| | - David Story
- 4 Anesthesia, Perioperative and Pain Medicine Unit, Melbourne Medical School, University of Melbourne, Victoria, Australia
| | - Rinaldo Bellomo
- 5 Department of Intensive Care, The University of Melbourne, Victoria, Australia
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Ergin B, Kapucu A, Guerci P, Ince C. The role of bicarbonate precursors in balanced fluids during haemorrhagic shock with and without compromised liver function. Br J Anaesth 2016; 117:521-528. [DOI: 10.1093/bja/aew277] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/28/2016] [Indexed: 12/18/2022] Open
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Reddy S, Weinberg L, Young P. Crystalloid fluid therapy. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2016; 20:59. [PMID: 26976277 PMCID: PMC4791913 DOI: 10.1186/s13054-016-1217-5] [Citation(s) in RCA: 58] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
This article is one of ten reviews selected from the Annual Update in Intensive Care and Emergency medicine 2016. Other selected articles can be found online at http://www.biomedcentral.com/collections/annualupdate2016. Further information about the Annual Update in Intensive Care and Emergency Medicine is available from http://www.springer.com/series/8901.
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Affiliation(s)
- Sumeet Reddy
- Medical Research Institute of New Zealand, 6021, Wellington, New Zealand.
| | - Laurence Weinberg
- Austin Hospital, Department of Anesthesia, Melbourne, VIC, Australia.,Departments of Surgery and Anesthesia, University of Melbourne, Perioperative Pain Medicine Unit, Melbourne, VIC, Australia
| | - Paul Young
- Medical Research Institute of New Zealand, 6021, Wellington, New Zealand.,Wellington Regional Hospital, Intensive Care Unit, Wellington, New Zealand
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Attari M, Sane S, Bordbar A. Comparison of the effects of two different formulas of fluids in craniotomy patients. Adv Biomed Res 2014; 3:257. [PMID: 25590035 PMCID: PMC4283248 DOI: 10.4103/2277-9175.146927] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2013] [Accepted: 12/06/2014] [Indexed: 11/08/2022] Open
Abstract
Background: Intraoperative fluid management of the patients who had undergone neurosurgery presents special challenges for the anesthesiologist. In this study, we aimed to compare the effects of two fluid combinations (half-normal + bicarbonate with saline + Ringer's lactate) on brain relaxation, and acid, base, and hemodynamic balance in patients undergoing elective craniotomy surgery. Materials and Methods: This randomized double-blind controlled clinical trial study was done on 50 patients, of age 20–60 years, undergoing craniotomy in Alzahra Hospital in 2012. They were divided in two groups of 25 patients each. In the control group, after the patients received hypertonic saline, normal saline serum and Ringer's lactate was administered, and in the half-normal study group, 80 ml of sodium bicarbonate for every liter of it was added. Arterial blood gas (ABG) was taken before the last suture. Brain relaxation before dura opening was registered. Results: There was no significant difference in heart rate changes (P = 0.054). No significant difference was observed in the mean arterial pressure between the two groups (P = 0.99). Changes in pH, HCO3, and BE were not significantly different (P = 0.99) between the two groups. Urine output in half-normal saline group was significantly higher than in normal saline group. The mean bleeding volume was higher in normal saline group, but was not significantly different (P = 0.54). The mean volume of injected blood was higher in half-normal group with a significant difference (P = 0.54). The injected blood volume mean in half-normal group was higher with no significant difference (P = 0.55). The mean of brain relaxation was not different (P = 0.5). Conclusion: These two fluids did not show any significant differences in the studied variables in this research.
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Affiliation(s)
- Mohammadali Attari
- Department of Anesthesiology and Critical Care, Alzahra Anesthesiology and Critical Care Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Shahryar Sane
- Department of Neuroanesthesiology, Alzahra Anesthesiology and Critical Care Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Akbar Bordbar
- Department of Anesthesiology, Alzahra Anesthesiology and Critical Care Center, Isfahan University of Medical Sciences, Isfahan, Iran
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Elbers P, Gatz R. Crystalloid resuscitation in hemorrhagic shock. Resuscitation 2012; 83:e172; author reply e173. [DOI: 10.1016/j.resuscitation.2012.03.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2012] [Accepted: 03/06/2012] [Indexed: 10/28/2022]
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10
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Davies PG, Venkatesh B, Morgan TJ, Presneill JJ, Kruger PS, Thomas BJ, Roberts MS, Mundy J. Plasma acetate, gluconate and interleukin-6 profiles during and after cardiopulmonary bypass: a comparison of Plasma-Lyte 148 with a bicarbonate-balanced solution. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2011; 15:R21. [PMID: 21235742 PMCID: PMC3222055 DOI: 10.1186/cc9966] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/30/2010] [Revised: 12/18/2010] [Accepted: 01/14/2011] [Indexed: 12/21/2022]
Abstract
INTRODUCTION As even small concentrations of acetate in the plasma result in pro-inflammatory and cardiotoxic effects, it has been removed from renal replacement fluids. However, Plasma-Lyte 148 (Plasma-Lyte), an electrolyte replacement solution containing acetate plus gluconate is a common circuit prime for cardio-pulmonary bypass (CPB). No published data exist on the peak plasma acetate and gluconate concentrations resulting from the use of Plasma-Lyte 148 during CPB. METHODS Thirty adult patients were systematically allocated 1:1 to CPB prime with either bicarbonate-balanced fluid (24 mmol/L bicarbonate) or Plasma-Lyte 148. Arterial blood acetate, gluconate and interleukin-6 (IL-6) levels were measured immediately before CPB (T1), three minutes after CPB commencement (T2), immediately before CPB separation (T3), and four hours post separation (T4). RESULTS Acetate concentrations (normal 0.04 to 0.07 mmol/L) became markedly elevated at T2, where the Plasma-Lyte group (median 3.69, range (2.46 to 8.55)) exceeded the bicarbonate group (0.16 (0.02 to 3.49), P < 0.0005). At T3, levels had declined but the differential pattern remained apparent (Plasma-Lyte 0.35 (0.00 to 1.84) versus bicarbonate 0.17 (0.00 to 0.81)). Normal circulating acetate concentrations were not restored until T4. Similar gluconate concentration profiles and inter-group differences were seen, with a slower T3 decay. IL-6 increased across CPB, peaking at T4, with no clear difference between groups. CONCLUSIONS Use of acetate containing prime solutions result in supraphysiological plasma concentrations of acetate. The use of acetate-free prime fluid in CPB significantly reduced but did not eliminate large acetate surges in cardiac surgical patients. Complete elimination of acetate surges would require the use of acetate free bolus fluids and cardioplegia solutions. TRIAL REGISTRATION Australia and New Zealand Clinical Trials Register (ANZCTR): ACTRN12610000267055.
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Affiliation(s)
- Paul G Davies
- DDepartment of Anaesthesia, Princess Alexandra Hospital, University of Queensland, Ipswich Road, Woolloongabba, QLD 4102, Australia
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Rozec B, Blanloeil Y, Fernandez M, Cinotti R, Videcoq M, Lejus C. Nature du priming de la circulation extracorporelle en chirurgie cardiaque adulte et pédiatrique. Ing Rech Biomed 2010. [DOI: 10.1016/s1959-0318(10)70004-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Liskaser F, Story DA, Hayhoe M, Poustie SJ, Bailey MJ, Bellomo R. Effect of pump prime on acidosis, strong-ion-difference and unmeasured ions during cardiopulmonary bypass. Anaesth Intensive Care 2010; 37:767-72. [PMID: 19775041 DOI: 10.1177/0310057x0903700512] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
We tested the hypothesis that a cardiopulmonary bypass prime with lactate would be associated with less acidosis than a prime with only chloride anions because of differences in the measured strong-ion-difference. We randomised 20 patients to a 1500 ml bypass prime with either a chloride-only solution (Ringer's Injection; anions: chloride 152 mmol/l) or a lactated solution (Hartmann's solution; anions: chloride 109 mmol/l, lactate 29 mmol/l). Arterial blood was sampled before bypass and then two, five, 15 and 30 minutes after initiating bypass. We used repeated measures analysis of variance to compare groups. In both groups, the base-excess and measured strong-ion-difference decreased markedly from baseline after two minutes of bypass. The chloride-only group had greater acidosis with lower base-excess and pH (P < 0.05), greatest after five minutes of bypass (C5). Contrary to our hypothesis, however, the difference between the groups was not due to a difference in the measured strong-ion-difference, P = 0.88. At C5 when the difference in standard base-excess between the groups was greatest, 1.9 mmol/l (95% confidence interval: 0.1 to 3.6 mmol/l, P < 0.05), the difference in the measured strong-ion-difference was only 0.2 mmol/l (95% confidence interval: -2.4 to 2.7 mmol/l, P > 0.05). There was, however a difference in the net-unmeasured-ions (strong-ion-gap). We conclude that acid-base changes with cardiopulmonary bypass may differ with the prime but that the early differences between chloride-only and lactated primes appear not to be due to differences in the measured strong-ion-difference. We suggest future studies examine other possible mechanisms including unmeasured ions.
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Affiliation(s)
- F Liskaser
- Department of Anaesthesia, Austin Health, Heidelberg, Victoria, Australia
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Morgan TJ, Vellaichamy M, Cowley DM, Weier SL, Venkatesh B, Jonest MA. Equivalent Metabolic Acidosis with Four Colloids and Saline on Ex Vivo Haemodilution. Anaesth Intensive Care 2009; 37:407-14. [DOI: 10.1177/0310057x0903700304] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Colloid infusions can cause metabolic acidosis. Mechanisms and relative severity with different colloids are incompletely understood. We compared haemodilution acid-base effects of 4% albumin, 3.5% polygeline, 4% succinylated gelatin (all weak acid colloids, strong ion difference 12 mEq/l, 17.6 mEq/l and 34 mEq/l respectively), 6% hetastarch (non-weak acid colloid, strong ion difference zero) and 0.9% saline (crystalloid, strong ion difference zero). Gelatin weak acid properties were tracked via the strong ion gap. Four-step ex vivo dilutions of pre-oxygenated human venous blood were performed to a final [Hb] near 50% baseline. With each fluid, base excess fell to approximately −13 mEq/l. Base excess/[Hb] relationships across dilution were linear and direct (R2 ≥0.96), slopes and intercepts closely resembling saline. Baseline strong ion gap was −0.3 (2.1) mEq/l. Post-dilution increases occurred in three groups: small with saline, hetastarch and albumin (to 3.5 (02) mEq/l, 4.3 (0.3) mEq/l, 3.3 (1.4) mEq/l respectively), intermediate with polygeline (to 12.2 (0.9) mEq/l) and greatest with succinylated gelatin (to 20.8 (1.4) mEq/l). We conclude that, despite colloid weak acid activity ranging from zero (hydroxyethyl starch) to greater than that of albumin with both gelatin preparations, ex vivo dilution causes a metabolic acidosis of identical severity to saline in each case. This uniformity reflects modifications to the albumin and gelatin saline vehicles, in part aimed at pH correction. By proportionally increasing the strong ion difference, these modifications counter deviations from pure saline effects caused by colloid weak acid activity. Extrapolation in vivo requires further investigation.
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Affiliation(s)
- T. J. Morgan
- Adult Intensive Care Unit and Department of Chemical Pathology, Mater Health Services, Brisbane, Queensland, Australia
- Intensive Care Unit, Mater Adult Hospital, Mater Health Services
| | - M. Vellaichamy
- Adult Intensive Care Unit and Department of Chemical Pathology, Mater Health Services, Brisbane, Queensland, Australia
- Intensive Care Unit, Toowoomba General Hospital, Toowoomba
| | - D. M. Cowley
- Adult Intensive Care Unit and Department of Chemical Pathology, Mater Health Services, Brisbane, Queensland, Australia
- Chemical Pathology, Mater Health Services Pathology, Mater Health Services
| | - S. L. Weier
- Adult Intensive Care Unit and Department of Chemical Pathology, Mater Health Services, Brisbane, Queensland, Australia
- Mater Health service Pathology, Mater Health Services
| | - B. Venkatesh
- Adult Intensive Care Unit and Department of Chemical Pathology, Mater Health Services, Brisbane, Queensland, Australia
- Intensive Care, Intensive Care Units, Princess Alexandra and Wesley Hospitals, University of Queensland
| | - M. A. Jonest
- Adult Intensive Care Unit and Department of Chemical Pathology, Mater Health Services, Brisbane, Queensland, Australia
- Queensland Clinical Trials Centre, University of Queensland, Princess Alexandra Hospital
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