Hyperchloremic Acidosis Increases Circulating Inflammatory Molecules in Experimental Sepsis

Ringer’s lactate is compatible with the rapid infusion of AS-3 preserved packed red blood cells

“…Large volume saline infusion produces acidosis by directly diluting the bicarbonate (HCO 3 -) concentration and by increasing plasma chloride relative to plasma sodium. 4 In the kidneys, a higher concentration of Cl -reciprocally leads to an increase in excretion of HCO 3 -contributing to the development of an anion gap metabolic acidosis. 3 Studies performed in animals have shown that treatment of hemorrhagic shock with NS, when compared to balanced salt solutions or RL, leads to an exacerbation of pre-existing acidosis and increased mortality.…”

“…3 Studies performed in animals have shown that treatment of hemorrhagic shock with NS, when compared to balanced salt solutions or RL, leads to an exacerbation of pre-existing acidosis and increased mortality. 4,16,17 This finding is significant in that acidosis is associated with impaired cardiac performance, decreased renal perfusion, and poor prognosis. 2,3 It has also been shown to increase perioperative blood loss and to raise the level of circulating inflammatory cytokines, such as tumour necrosis factor and interleukins 6 and 10.…”

“…2,3 It has also been shown to increase perioperative blood loss and to raise the level of circulating inflammatory cytokines, such as tumour necrosis factor and interleukins 6 and 10. 4,5 Thus, RL may be a more logical choice for resuscitation of hemorrhagic shock. 2,3,6 It is postulated that RL may improve metabolic acidosis through in vivo conversion of its lactate component to circulating bicarbonate.…”

“…Although inexpensive and accessible, administering large volumes of NS, but not RL, has been shown to cause hyperchloremic metabolic acidosis and disturbances in electrolyte homeostasis. [2][3][4][5] Thus, it has been suggested that RL is the initial fluid of choice for resuscitating the patient in hemorrhagic shock. 2,3,6 Crystalloids are generally co-administered with packed red blood cells (PRBC) in order to prime and flush intravenous tubing and often to dilute the blood to improve flow characteristics.…”

Balanced versus isotonic saline resuscitation—a systematic review and meta-analysis of randomized controlled trials in operation rooms and intensive care units

“…The potential clinical benefit from resuscitation with balanced solutions comes from the lower chloride content, as development of dilutional acidosis could increase the inflammatory response (6,7), and decrease splanchnic perfusion (8), myocardial contractility (9) and the cardiovascular catecholamine response (10). It is highly uncertain, however, whether prevention of dilutional acidosis has an effect on clinically relevant outcomes in patients who need fluid resuscitation for shock.…”