Does fluid resuscitation with balanced solutions induce electrolyte and metabolic abnormalities? An in vitro assessment

Abstract

A b s t r a c tBackground: Popular intravenous fluids in clinical use may have an impact on electrolyte concentration and metabolic balance and should be considered as powerful pharmacological agents. There is a growing body of evidence that fluid therapy should be more individualised and preferably based on balanced solutions. Aim:We sought to investigate the impact of three commonly used balanced fluids on electrolytes and metabolic equilibrium in an in vitro setting. Methods:Study group comprised 32 healthy male volunteers (without history of any acute/chronic disorder or known metabolic abnormality), aged 21-35 (29 ± 4) years, weight 59-103 (81.2 ± 9.8) kg, from whom blood samples were withdrawn. The whole blood was diluted in 4:1 ratio with the study solutions to make an end-concentration of 20 vol.% of each solution. The test solutions included balanced crystalloid (Plasmalyte All test solutions caused a similar statistically significant (p < 0.05) drop in base excess and bicarbonate concentration, and these fell outside the reference values. Due to its composition, GEL caused a significant increase in lactate concentration. HES and GEL caused a statistically significant drop in strong ion difference value. Due to high lactate level, the effect of GEL was most pronounced.Conclusions: Balanced intravenous solutions should be safe in terms of their impact on human plasma electrolyte and metabolic equilibrium when administered to replace up to 20% of blood volume. In metabolic acidosis, balanced succinylated gelatin should be used with caution. Therefore, arterial blood gas analysis should be performed in patients in whom significant amounts of fluid are administrated, preferably with assessment of Cl -, Na + , lactate concentrations as well as pH, osmolality, and strong ion difference.

The importance of fluid balance in critically ill patients: a retrospective observational study

“…35 Adverse effects of crystalloid and colloid solutions have been well documented. 36 Krzych and Czempik, 37 in their experimental ex vivo study, confirmed that commonly used balanced fluids had little impact on electrolyte composition of human plasma. However, in metabolic acidosis, succinylated gelatin should be used with caution due the presence of lactate as a buffering agent.…”

Comparisons of Electrolyte Balance Efficacy of Two Gelatin-Balanced Crystalloid for Surgery Patients Under General Anesthesia: A Multi-Center, Prospective, Randomized, Single-Blind, Controlled Study

“… 24 Moreover, Succinyl gelatin has the side effect of electrolyte disturbance because it contains saline solution in which the level of CL − and Na + is higher than that in normal plasma. 5 , 6 , 25 The Ca 2+ , K + levels can also be reduced for the sake of blood dilution, ion flow, and increased urine volume among the patients with operations under general anesthesia. 5 , 6 , 25 Succinyl gelatin infusion at a dose of 10 mL/kg and a rate of 20 mL/min is shown to achieve effective dilatation without causing serious hemodynamic change and adverse events.…”

“… 22–27 Administered with up to 20% of blood volume with balanced intravenous solutions is safe in terms of their impact on human plasma electrolyte and metabolic equilibrium. 25 …”

“…Another study compared perioperative infusion of colloids and crystalloids in cardiac surgery patients and found no significant correlation between the infusion of either and postoperative acute kidney injury and mortality. 30 Moreover, preoperative fasting and restricted drinking and the side effect of Succinyl gelatin may also cause hemodynamic change, 5 , 6 , 25 which may prolong APTT. Therefore, individualized fluid management plan should be adjusted and optimized intraoperatively based on the monitoring of patients’ conditions and other indicators, so as to facilitate patient recovery and reduce complications.…”

“…5,6,25 The Ca 2+ , K + levels can also be reduced for the sake of blood dilution, ion flow, and increased urine volume among the patients with operations under general anesthesia. 5,6,25 Succinyl gelatin infusion at a dose of 10 mL/kg and a rate of 20 mL/min is shown to achieve effective dilatation without causing serious hemodynamic change and adverse events. [22][23][24][25][26][27] Administered with up to 20% of blood volume with balanced intravenous solutions is safe in terms of their impact on human plasma electrolyte and metabolic equilibrium.…”