Dilutional Acidosis or Altered Strong Ion Difference

Dorje, Pema; Adhikary, Gaury S.; McLaren, Ian D.; Bogush, Stephen

doi:10.1097/00000542-199710000-00052

“…A change in the chloride concentration is the major anionic contributor to the change in H + homoeostasis. Hyperchloraemia caused by a saline infusion, therefore, will decrease the strong ion difference and result in a metabolic acidosis [7,14,16,17]. Although the volume of fluid replacement in Scheingraber's study [7] may be considered excessive, that study provided conclusive evidence that hyperchloraemic acidosis accompanies saline infusions, confirming the earlier observations of McFarlane and Lee [18], who demonstrated a less severe acidosis after the infusion of 3 litres over 200 min.…”

Section: Discussionsupporting

confidence: 81%

(Ab)normal saline and physiological Hartmann's solution: a randomized double-blind crossover study

Reid

¹

,

Lobo

²

,

Williams

³

et al. 2002

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In this double-blind crossover study, the effects of bolus infusions of 0.9% saline (NaCl) and Hartmann's solution on serum albumin, haematocrit and serum and urinary biochemistry were compared in healthy subjects. Nine young adult male volunteers received 2-litre intravenous infusions of 0.9% saline and Hartmann's solution on separate occasions, in random order, each over 1 h. Body weight, haematocrit and serum biochemistry were measured pre-infusion and at 1 h intervals for 6 h. Biochemical analysis was performed on pooled post-infusion urine. Blood and plasma volume expansion, estimated by dilutional effects on haematocrit and serum albumin, were greater and more sustained after saline than after Hartmann's solution (P <0.01). At 6 h, body weight measurements suggested that 56% of the infused saline was retained, in contrast with only 30% of the Hartmann's solution. Subjects voided more urine (median: 1,000 compared with 450 ml) of higher sodium content (median: 122 compared with 73 mmol) after Hartmann's than after saline (both P =0.049), despite the greater sodium content of the latter. The time to first micturition was less after Hartmann's than after saline (median: 70 compared with 185 min; P =0.008). There were no significant differences between the effects of the two solutions on serum sodium, potassium, urea or osmolality. After saline, all subjects developed hyperchloraemia (>105 mmol/l), which was sustained for >6 h, while serum chloride concentrations remained normal after Hartmann's (P <0.001 for difference between infusions). Serum bicarbonate concentration was significantly lower after saline than after Hartmann's (P =0.008). Thus excretion of both water and sodium is slower after a 2-litre intravenous bolus of 0.9% saline than after Hartmann's solution, due possibly to the more physiological [Na(+)]/[Cl(-)] ratio in Hartmann's solution (1.18:1) than in saline (1:1) and to the hyperchloraemia caused by saline.

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“…Stewart [12] has described a mathematical approach to acid-base balance in which the strong ion difference ([Na + ]j[K + ]k[Cl − ]) in the body is the major determinant of the H + ion concentration. Hyperchloraemia caused by a saline infusion, therefore, will decrease the strong ion difference and result in a metabolic acidosis [7,14,16,17]. A change in the chloride concentration is the major anionic contributor to the change in H + homoeostasis.…”

Section: Discussionmentioning

confidence: 99%

(Ab)normal saline and physiological Hartmann’s solution: a randomized double-blind crossover study

Reid

¹

,

Lobo

²

,

Williams

³

et al. 2003

View full text Add to dashboard Cite

In this double-blind crossover study, the effects of bolus infusions of 0.9% saline (NaCl) and Hartmann's solution on serum albumin, haematocrit and serum and urinary biochemistry were compared in healthy subjects. Nine young adult male volunteers received 2-litre intravenous infusions of 0.9% saline and Hartmann's solution on separate occasions, in random order, each over 1 h. Body weight, haematocrit and serum biochemistry were measured pre-infusion and at 1 h intervals for 6 h. Biochemical analysis was performed on pooled post-infusion urine. Blood and plasma volume expansion, estimated by dilutional effects on haematocrit and serum albumin, were greater and more sustained after saline than after Hartmann's solution (P <0.01). At 6 h, body weight measurements suggested that 56% of the infused saline was retained, in contrast with only 30% of the Hartmann's solution. Subjects voided more urine (median: 1,000 compared with 450 ml) of higher sodium content (median: 122 compared with 73 mmol) after Hartmann's than after saline (both P =0.049), despite the greater sodium content of the latter. The time to first micturition was less after Hartmann's than after saline (median: 70 compared with 185 min; P =0.008). There were no significant differences between the effects of the two solutions on serum sodium, potassium, urea or osmolality. After saline, all subjects developed hyperchloraemia (>105 mmol/l), which was sustained for >6 h, while serum chloride concentrations remained normal after Hartmann's (P <0.001 for difference between infusions). Serum bicarbonate concentration was significantly lower after saline than after Hartmann's (P =0.008). Thus excretion of both water and sodium is slower after a 2-litre intravenous bolus of 0.9% saline than after Hartmann's solution, due possibly to the more physiological [Na(+)]/[Cl(-)] ratio in Hartmann's solution (1.18:1) than in saline (1:1) and to the hyperchloraemia caused by saline.

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“…• Diferença de íons forte aparente (SIDa): é a diferença entre os cátions abundantes no organismo (Na + , K + , Mg 2+ e Ca 2+ ) e os ânions (Cl -, lactato) [20][21][22] . Esse SID é chamado de aparente porque não leva em consideração ácidos fracos como albumina e fosfato, que também podem estar presentes influenciando o valor do SID.…”

Section: Método De Stewart-fencl-figgeunclassified

Avaliação da acidose metabólica em pacientes graves: método de Stewart-Fencl-Figge versus a abordagem tradicional de henderson-hasselbalch

Barbosa¹,

Alves²,

Filho³

2006

Rev. bras. ter. intensiva

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JUSTIFICATIVA E OBJETIVOS: Rever estratégias de avaliação da acidose metabólica dando ênfase ao método de Stewart-Fencl-Figge versus a abordagem tradicional de Henderson-Hasselbalch. CONTEÚDO: A acidose metabólica é um distúrbio comum em pacientes criticamente enfermos, sendo importante causa de depressão da função miocárdica e sensível indicador de má perfusão tissular. Tradicionalmente, é avaliada através do método de Henderson-Hasselbalch no qual a gasometria arterial fornece informações sobre a existência e o tipo de distúrbio ácido-básico. Porém, nem sempre, esse método é capaz de explicar os seus mecanismos causais e,

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Dilutional Acidosis or Altered Strong Ion Difference

Cited by 15 publications

References 5 publications

(Ab)normal saline and physiological Hartmann's solution: a randomized double-blind crossover study

(Ab)normal saline and physiological Hartmann's solution: a randomized double-blind crossover study

(Ab)normal saline and physiological Hartmann’s solution: a randomized double-blind crossover study

Avaliação da acidose metabólica em pacientes graves: método de Stewart-Fencl-Figge versus a abordagem tradicional de henderson-hasselbalch

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