Effect of lactate versus acetate-based intravenous fluids on acid-base balance in patients undergoing free flap reconstructive surgeries

Rajan, Sunil; Srikumar, Soumya; Tosh, Pulak; Kumar, Lakshmi

doi:10.4103/joacp.joacp_18_17

Cited by 15 publications

(2 citation statements)

References 20 publications

(20 reference statements)

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“…Given these implications, it is essential to manage healthy L-lactate levels. Various treatment methods have been developed, including oxygen therapy [8] , intravenous fluid replenishment [9] , medications targeting LDH [10] or lactate transporters [11] , and addressing associated symptoms or organ dysfunctions. However, these methods do not directly target lactate itself, are often expensive, and require specific environments, limiting their widespread use.…”

Section: Introductionmentioning

confidence: 99%

“…Given these implications, strategies to accelerate the clearance of 3 excess lactate and promote the maintenance of healthy blood lactate values possess great utility in the clinical setting. Various lactate-centric treatment methods have been developed, including oxygen therapy (9), intravenous fluid replenishment (10), and medications targeting LDH (11) or lactate transporters (12). However, most of these methods do not directly target lactate itself.…”

Section: Introductionmentioning

confidence: 99%

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EngineeredBacillus subtilisas oral probiotics to enhance clearance of blood lactate

Yang,

Hutchinson,

et al. 2023

Preprint

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Lactic acid or lactate, a key byproduct of anaerobic glycolysis, plays pivotal roles in routine metabolism. An increase in lactic acid is observed in various pathological conditions such as cancer, diabetes, genetic mitochondrial disease, and aging. While several groups have proposed small molecule inhibitors to reduce circulating lactic acid, there are few clinically relevant ways to manage acute or chronic elevations in lactic acid in patients. In addition, recent evidence suggests that lactic acid exchanges between the gut, blood, and peripheral tissues, and professional marathon runners harbor specific gut microbial species that more efficiently metabolize lactic acid. Inspired by these findings, this work sought to engineer probioticB. subtilisstrains to express lactate oxidase that could increase circulating lactic acid catabolism after delivery to the gut. After optimization, oral administration of engineeredB. subtilisto the gut of mice reduced the elevation in blood lactic acid levels after exogenous lactic acid challenge without affecting normal gut microbiota composition, inflammation or liver enzymes. Taken together, through the oral delivery of engineered probiotics to the gastrointestinal tract, our proof-of-concept study offers a new opportunity to therapeutically target diseases where blood lactic acid is elevated, and provides a new approach to “knocking down” metabolites to help understand the roles of metabolites in host physiological and pathological processes.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

EngineeredBacillus subtilisas oral probiotics to enhance clearance of blood lactate

Yang,

Hutchinson,

et al. 2023

Preprint

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Balanced Solutions: Choice of Buffer

Garg

2023

Rational Use of Intravenous Fluids in Critically Ill Patients

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Increased crystalloid fluid requirements during zone 3 Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) versus Abdominal Aortic and Junctional Tourniquet (AAJT) after class II hemorrhage in swine

Brännström

Dahlquist

Gustavsson

et al. 2021

Eur J Trauma Emerg Surg

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Purpose Pelvic and lower junctional hemorrhage result in a significant amount of trauma related deaths in military and rural civilian environments. The Abdominal Aortic and Junctional Tourniquet (AAJT) and infra-renal (zone 3) Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) are two options for resuscitation of patients with life threatening blood loss from and distal to the pelvis. Evidence suggest differences in the hemodynamic response between AAJT and zone 3 REBOA, but fluid management during resuscitation with the devices has not been fully elucidated. We compared crystalloid fluid requirements (Ringer’s acetate) between these devices to maintain a carotid mean arterial pressure (MAP) > 60 mmHg. Methods 60 kg anesthetized and mechanically ventilated male pigs were subjected to a mean 1030 (range 900–1246) mL (25% of estimated total blood volume, class II) haemorrhage. AAJT (n = 6) or zone 3 REBOA (n = 6) were then applied for 240 min. Crystalloid fluids were administered to maintain carotid MAP. The animals were monitored for 30 min after reperfusion. Results Cumulative resuscitative fluid requirements increased 7.2 times (mean difference 2079 mL; 95% CI 627–3530 mL) in zone 3 REBOA (mean 2412; range 800–4871 mL) compared to AAJT (mean 333; range 0–1000 mL) to maintain target carotid MAP. Release of the AAJT required vasopressor support with norepinephrine infusion for a mean 9.6 min (0.1 µg/kg/min), while REBOA release required no vasopressor support. Conclusion Zone 3 REBOA required 7.2 times more crystalloids to maintain the targeted MAP. The AAJT may therefore be considered in a situation of hemorrhagic shock to limit the need for crystalloid infusions, although removal of the AAJT caused more severe hemodynamic and metabolic effects which required vasopressor support.

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Effect of lactate versus acetate-based intravenous fluids on acid-base balance in patients undergoing free flap reconstructive surgeries

Cited by 15 publications

References 20 publications

EngineeredBacillus subtilisas oral probiotics to enhance clearance of blood lactate

EngineeredBacillus subtilisas oral probiotics to enhance clearance of blood lactate

Balanced Solutions: Choice of Buffer

Increased crystalloid fluid requirements during zone 3 Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) versus Abdominal Aortic and Junctional Tourniquet (AAJT) after class II hemorrhage in swine

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