Comparison of Commercially Available Balanced Salt Solution and Ringer's Lactate on Extent of Correction of Metabolic Acidosis in Critically Ill Patients
Citation Information :
Comparison of Commercially Available Balanced Salt Solution and Ringer's Lactate on Extent of Correction of Metabolic Acidosis in Critically Ill Patients. Indian J Crit Care Med 2020; 24 (7):539-543.
Introduction: Appropriate early fluid resuscitation is ubiquitous for critically ill patients with metabolic acidosis. Owing to harmful effects of normal saline, commercially prepared balanced salt solutions are being used. However, there is no study comparing use of Ringer's lactate (RL) and commercially available balanced salt solutions in critically ill patients. Materials and methods: A randomized controlled trial was conducted during July 2016 to December 2017. Fifty adult patients admitted to intensive care unit with metabolic acidosis were randomized into group RL or group acetate solution (AC). Respective trial fluid was administered at 20 mL/kg/hour for first hour and 10 mL/kg/hour for second hour. Arterial blood gas analysis samples were taken 15 minutes apart. The fluid resuscitation was continued till pH got corrected to 7.3 or 2 hours, whichever was earlier. The primary aim was to compare time to correct metabolic acidosis in both the groups. The secondary outcomes were the extent of correction of metabolic acidosis, total volume of fluid used, and total cost per patient. Results: Demographic parameters, APACHE II score, and baseline investigations were comparable. The metabolic acidosis got corrected in 12 patients in group AC and 10 patients in group RL (p value = 0.66). The mean time for correction of metabolic acidosis was 57 ± 3.85 minutes in group RL and 56.25 ± 4.22 minutes in group AC (p value =0.95). The extent of correction of metabolic acidosis and total volume of fluid used was also comparable (p value = 0.05). However, the cost of fluid used was significantly higher in group AC (p value < 0.01). Conclusion: During administration of balanced salt solutions, RL or AC, in critically ill patients with metabolic acidosis, AC did not confer any advantage in time to or extent of correction of metabolic acidosis. Clinical significance: There is no difference in acid–base status with use of different types of balanced salt solutions for resuscitation in critically ill patients.
Kellum JA. Metabolic acidosis in patients with sepsis: epiphenomenon or part of the pathophysiology? Crit Care Resusc 2004;6(3):197–203.
Skellett S, Mayer A, Durward A, Tibby SM, Murdoch IA. Chasing the base deficit: hyperchloraemic acidosis following 0.9% saline fluid resuscitation. Arch Dis Child 2000;83(6):514–516. DOI: 10.1136/adc.83.6.514.
Myburgh JA, Mythen MG. Resuscitation fluids. N Engl J Med 2013;369(13):1243–1251. DOI: 10.1056/NEJMra1208627.
Kraut JA, Madias NE. Treatment of acute metabolic acidosis: a pathophysiologic approach. Nat Rev Nephrol 2012;8(10):589–601. DOI: 10.1038/nrneph.2012.186.
Semler MW, Self WH, Wanderer JP, Ehrenfeld JM, Wang L, et al. Balanced crystalloid versus saline in critically ill adults. N Engl J Med 2018;378(9):829–839. DOI: 10.1056/NEJMoa1711584.
Liu C, Mao Z, Hu P, Hu X, Kang H, Hu J, et al. Fluid resuscitation in critically ill patients: a systematic review and network meta-analysis. Ther Clin Risk Manag 2018;14:1701–1709. DOI: 10.2147/TCRM.S175080.
Chowdhury AH, Cox EF, Francis ST, Lobo DN. A randomized, controlled, double-blind crossover study on the effects of 2-L infusions of 0.9% saline and plasmalyte (R) 148 on renal blood flow velocity and renal cortical tissue perfusion in healthy volunteers. Ann Surg 2012;256(1):18–24. DOI: 10.1097/SLA.0b013e318256be72.
Shaw AD, Bagshaw SM, Goldstein SL, Scherer LA, Duan M, Schermer CR, et al. Major complications, mortality and resource utilization after open abdominal surgery: 0.9% saline compared to Plasma-Lyte. Ann Surg 2012;255(5):821–829. DOI: 10.1097/SLA.0b013e31825074f5.
Young JB, Utter GH, Schermer CR, Galante JM, Phan HH, Yang Y, et al. Saline versus plasmalyte a in initial resuscitation of trauma patients: a randomized trial. Ann Surg 2014;259(2):255–262. DOI: 10.1097/SLA.0b013e318295feba.
Casey JD, Brown RM, Semler MW. Resuscitation fluids. Curr Opin Crit Care 2018;24(6):512–518. DOI: 10.1097/MCC.0000000000000551.
Hadimioglu N, Saadawy I, Saglam T, Ertug Z, Dinckan A. The effect of different crystalloid solutions on acid-base balance and early kidney function after kidney transplantation. Anesth Analg 2008;107(1):264–269. DOI: 10.1213/ane.0b013e3181732d64.
Weinberg L, Pearce B, Sullivan R, Siu L, Scurrah N, Tan C, et al. The effects of plasmalyte-148 vs Hartmann's solution during major liver resection: a multicenter, double-blind, randomized controlled trial. Minerva Anesthesiol 2015;81(12):1288–1297.
Shin WJ, Kim YK, Bang JY, Cho SK, Han SM, Hwang GS. Lactate and liver function tests after living donor right hepatectomy: a comparison of solutions with and without lactate. Acta Anaesthesiol Scand 2011;55(5):558. DOI: 10.1111/j.1399-6576.2011.02398.x-64.
Chua HR, Venkatesh B, Stachowski E, Schneider AG, Perkins K, Ladanyi S, et al. Plama-lyte 148 vs 0.9% saline for fluid resuscitation in diabetic ketoacidosis. J Crit Care 2012;27(2):138–145. DOI: 10.1016/j.jcrc.2012.01.007.
Mahler SA, Conrad SA, Wang H, Arnold TC. Resuscitation with balanced electrolyte solution prevents hyperchloremic metabolic acidosis in patients with diabetic ketoacidosis. Am J Emerg Med 2011;29(6):670–674. DOI: 10.1016/j.ajem.2010.02.004.
Noritomi DT, Pereira AJ, Bugano DD, Rehder PS, Silva E. Impact of plasmalyte pH-7.4 on acid base status and haemodynamics in a model of controlled hemorrhagic shock. Clinics (Sao Paulo) 2011;66(11):1969–1974. DOI: 10.1590/S1807-59322011001100019.