Acid–Base Changes Caused by 5% Albumin versus  6% Hydroxyethyl Starch Solution in Patients Undergoing Acute Normovolemic Hemodilution

Abstract

ANH with 5% albumin or 6% hydroxyethyl starch solutions led to metabolic acidosis. A dilution of extracellular bicarbonate or changes in strong ion difference and albumin concentration offer explanations for this type of acidosis.

Lactic and hydrochloric acids induce different patterns of inflammatory response in LPS-stimulated RAW 264.7 cells

“…Although common causes of metabolic acidosis, such as lactic acidosis and renal failure, may be unavoidable, often the source of metabolic acidosis is at least partly iatrogenic, because saline resuscitation is often used to treat shock. Large-volume saline infusion produces metabolic acidosis by increasing the plasma Cl Ϫ concentration relative to the plasma Na ϩ concentration (18,27,31,32,41,42). The result is a reduction in the strong ion difference, the difference between positively and negatively charged electrolytes, which in turn produces an increase in free H ϩ to preserve electrical neutrality (38).…”

“…However, different studies have used different acids to lower pH o , and no studies have compared the effects of different forms of clinically relevant acidosis on the immune response. Because critically ill and injured patients may be adversely affected by even short-term alterations in the immune response (augmentation and attenuation) and because some forms of metabolic acidosis are largely iatrogenic (18,27,31,32,41,42), we believe that it is necessary to characterize the effects of acidosis on the immune response. We further believe that it is imperative that the mechanisms responsible for these effects be elucidated.…”

Post‐operative volume therapy in cardiac surgery: effects on hemostatic and circulatory variables

“…Albumin has been shown to induce mild metabolic acidosis in patients undergoing normovolemic hemodilution during surgery, a process explained by the changes in SID (Rehm et al 2000). The frequency of allergic reactions with albumin is below 0.1% (Laxenaire et al 1994).…”

Unappreciated aspects of fluid and electrolyte physiology and implications to patient recovery

“…Hypertonic saline (3% salinity) can be tolerated in only relatively small volumes, and, in theory, normal saline can be provided as a maintenance solution, but only if the kidneys can maximally concentrate urine to [ 1,000 mOsmÁkg -1 . Since the ability to concentrate urine and the robustness of fluid/electrolyte physiology decreases with age 4 and concomitant renal disease, it is hardly surprising that using 0.9% normal saline as a ''maintenance solution'' can lead to hypernatremia, hyperchloremic acidosis, 5,6 and hyperosmolality with reduced urine output secondary to increased secretion of antidiuretic hormone. 7 Normal saline should be reserved for vascular volume replacement or expansion.…”

“…Une solution saline hypertonique (3 % de salinité) peut être tolérée seulement en volume relativement restreint et, en théorie, du sérum physiologique peut être administré comme solution de maintien, mais seulement si les reins peuvent concentrer l'urine de façon maximale à [ 1 000 mOsmÁkg -1 . É tant donné que la capacité de concentrer de l'urine et la robustesse de la physiologie liquidienne/ électrolytique diminue avec l'âge 4 et les maladies rénales concomitantes, il n'est dès lors pas surprenant que l'utilisation d'une solution saline à 0,9 % comme « solution de maintien » puisse provoquer de l'hypernatrémie, de l'acidose hyperchlorémique 5,6 et de l'hyperosmolalité en raison d'une production réduite d'urine secondaire à une sécrétion accrue de l'hormone antidiurétique. 7 Il faudrait réserver le sérum physiologique pour le remplacement ou l'expansion du volume vasculaire.…”