Impact of Plasma-Lyte pH 7.4 on acid-base status and hemodynamics in a model of controlled hemorrhagic shock

OBJECTIVE: Intravenous infusion of crystalloid solutions is a cornerstone of the treatment of hemorrhagic shock. However, crystalloid solutions can have variable metabolic acid-base effects, perpetuating or even aggravating shock-induced metabolic acidosis. The aim of this study was to compare, in a controlled volume–driven porcine model of hemorrhagic shock, the effects of three different crystalloid solutions on the hemodynamics and acid-base balance. METHODS: Controlled hemorrhagic shock (40% of the total blood volume was removed) was induced in 18 animals, which were then treated with normal saline (0.9% NaCl), Lactated Ringer's Solution or Plasma-Lyte pH 7.4, in a blinded fashion (n = 6 for each group). Using a predefined protocol, the animals received three times the volume of blood removed. RESULTS: The three different crystalloid infusions were equally capable of reversing the hemorrhage-induced low cardiac output and anuria. The Lactated Ringer's Solution and Plasma-Lyte pH 7.4 infusions resulted in an increased standard base excess and a decreased serum chloride level, whereas treatment with normal saline resulted in a decreased standard base excess and an increased serum chloride level. The Plasma-Lyte pH 7.4 infusions did not change the level of the unmeasured anions. CONCLUSION: Although the three tested crystalloid solutions were equally able to attenuate the hemodynamic and tissue perfusion disturbances, only the normal saline induced hyperchloremia and metabolic acidosis.

[1]  J. Kellum,et al.  Metabolic acidosis in patients with severe sepsis and septic shock: A longitudinal quantitative study , 2009, Critical care medicine.

[2]  J. Handy,et al.  Physiological effects of hyperchloraemia and acidosis. , 2008, British journal of anaesthesia.

[3]  A. Dınçkan,et al.  The Effect of Different Crystalloid Solutions on Acid-Base Balance and Early Kidney Function After Kidney Transplantation , 2008, Anesthesia and analgesia.

[4]  M. Revel,et al.  Comparison of two fluid-management strategies in acute lung injury, H.P. Wiedemann, A.P. Wheeler, G.R. Bernard, B.T. Thompson, D. Hayden, B. deBoisblanc, A.F Jr. Connors, R.D. Hite, A.L. Harabin, in: N Engl J Med, 354. (2006), 2564 , 2007 .

[5]  J. Kellum,et al.  Hyperchloremic acidosis increases circulating inflammatory molecules in experimental sepsis. , 2006, Chest.

[6]  Gordon R Bernard,et al.  Comparison of two fluid-management strategies in acute lung injury. , 2006, The New England journal of medicine.

[7]  J. Minei,et al.  Inflammation and the Host Response to Injury, a large-scale collaborative project: patient-oriented research core--standard operating procedures for clinical care. III. Guidelines for shock resuscitation. , 2006, The Journal of trauma.

[8]  J. Kellum,et al.  Lactate versus non-lactate metabolic acidosis: a retrospective outcome evaluation of critically ill patients , 2006, Critical care.

[9]  C. Sprung,et al.  Sepsis in European intensive care units: Results of the SOAP study* , 2006, Critical care medicine.

[10]  T. J. Morgan.  The meaning of acid–base abnormalities in the intensive care unit: Part III – effects of fluid administration , 2004, Critical care.

[11]  J. Kellum,et al.  Initial pH, base deficit, lactate, anion gap, strong ion difference, and strong ion gap predict outcome from major vascular injury* , 2004, Critical care medicine.

[12]  E. W. Wooten,et al.  Calculation of physiological acid-base parameters in multicompartment systems with application to human blood. , 2003, Journal of applied physiology.

[13]  D. Lobo,et al.  (Ab)normal saline and physiological Hartmann's solution: a randomized double-blind crossover study. , 2003, Clinical science.

[14]  E. Bennett-Guerrero,et al.  A prospective, randomized comparison of thromboelastographic coagulation profile in patients receiving lactated Ringer's solution, 6% hetastarch in a balanced-saline vehicle, or 6% hetastarch in saline during major surgery. , 2002, Journal of cardiothoracic and vascular anesthesia.

[15]  J. Kellum.  Fluid resuscitation and hyperchloremic acidosis in experimental sepsis: Improved short-term survival and acid-base balance with Hextend compared with saline , 2002, Critical care medicine.

[16]  J. Kellum.  Saline-induced hyperchloremic metabolic acidosis. , 2002, Critical care medicine.

[17]  R. Grounds,et al.  Base excess and lactate as prognostic indicators for patients admitted to intensive care , 2001, Intensive Care Medicine.

[18]  S. Mallett,et al.  The Effects of Balanced Versus Saline-Based Hetastarch and Crystalloid Solutions on Acid-Base and Electrolyte Status and Gastric Mucosal Perfusion in Elderly Surgical Patients , 2001, Anesthesia and analgesia.

[19]  A. Ho,et al.  Excessive use of normal saline in managing traumatized patients in shock: a preventable contributor to acidosis. , 2001, The Journal of trauma.

[20]  R. Bellomo,et al.  Role of Pump Prime in the Etiology and Pathogenesis of Cardiopulmonary Bypass–associated Acidosis , 2000, Anesthesiology.

[21]  G. Findlay,et al.  Blood volume determination by the carbon monoxide method using a new delivery system: accuracy in critically ill humans and precision in an animal model. , 1999, Critical care medicine.

[22]  S. Clack,et al.  Cause of metabolic acidosis in prolonged surgery. , 1999, Critical care medicine.

[23]  U. Finsterer,et al.  Rapid saline infusion produces hyperchloremic acidosis in patients undergoing gynecologic surgery. , 1999, Anesthesiology.

[24]  J. Mikhail.  The trauma triad of death: hypothermia, acidosis, and coagulopathy. , 1999, AACN clinical issues.

[25]  M. Healey,et al.  Lactated ringer's is superior to normal saline in a model of massive hemorrhage and resuscitation. , 1998, The Journal of trauma.

[26]  R. Bellomo,et al.  ETIOLOGY OF METABOLIC ACIDOSIS DURING SALINE RESUSCITATION IN ENDOTOXEMIA , 1998, Shock.

[27]  J. Kellum,et al.  Strong ion gap: a methodology for exploring unexplained anions. , 1995, Journal of critical care.

[28]  S. Shackford,et al.  Intravenous fluid tonicity: effect on intracranial pressure, cerebral blood flow, and cerebral oxygen delivery in focal brain injury. , 1992, Journal of neurosurgery.

[29]  V. Fencl,et al.  The role of serum proteins in acid-base equilibria. , 1991, The Journal of laboratory and clinical medicine.

[30]  J. Macarthur,et al.  Hypothermia and acidosis worsen coagulopathy in the patient requiring massive transfusion. , 1991, American journal of surgery.

[31]  P A Stewart,et al.  Modern quantitative acid-base chemistry. , 1983, Canadian journal of physiology and pharmacology.

[32]  C. Wilcox.  Regulation of renal blood flow by plasma chloride. , 1983, The Journal of clinical investigation.