Isotonic saline in elderly men: an open‐labelled controlled infusion study of electrolyte balance, urine flow and kidney function

Hahn, Robert G.; Isacson, Manuela; Fagerström, Tim; Rosvall, Jesper; Nyman, Claes R.

doi:10.1111/anae.13301

Cited by 30 publications

(35 citation statements)

References 22 publications

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“…The rate of elimination of crystalloid fluid is retarded if a volunteer is made dehydrated with furosemide or if a patient has concentrated urine as evidence of renal fluid retention . In the elderly, the plasma volume expansion is considerably greater if the voided urine is concentrated (urine osmolality >700 mosmol/kg) before the infusion starts …”

Section: Miscellaneousmentioning

confidence: 99%

Understanding volume kinetics

Hahn

2020

Acta Anaesthesiol Scand

106

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The distribution and elimination kinetics of the water volume in infusion fluids can be studied by volume kinetics. The approach is a modification of drug pharmacokinetics and uses repeated measurements of blood hemoglobin and urinary excretion as input variables in (usually) a two‐compartment model with expandable walls. Study results show that crystalloid fluid has a distribution phase that gives these fluids a plasma volume expansion amounting to 50%‐60% of the infused volume as long as the infusion lasts, while the fraction is reduced to 15%‐20% within 30 minutes after the infusion ends. Small volumes of crystalloid barely distribute to the interstitium, whereas rapid infusions tend to cause edema. Fluid elimination is very slow during general anesthesia due to the vasodilatation‐induced reduction of the arterial pressure, whereas elimination is less affected by hemorrhage. The half‐life is twice as long for saline than for Ringer solutions. Elimination is slower in conscious males than conscious females, and high red blood cell and thrombocyte counts retard both distribution and re‐distribution. Children have faster turnover than adults. Plasma volume expansions are similar for glucose solutions and Ringer's, but the expansion duration is shorter for glucose. Concentrated urine before and during infusion slows down the elimination of crystalloid fluid. Colloid fluids have no distribution phase, an intravascular persistence half‐life of 2‐3 hours, and—at least for hydroxyethyl starch—the ability to reduce the effect of subsequently infused crystalloids. Accelerated distribution due to degradation of the endothelial glycocalyx layer has not yet been demonstrated.

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Section: Miscellaneousmentioning

confidence: 99%

Understanding volume kinetics

Hahn

2020

Acta Anaesthesiol Scand

106

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“…These negative effects may be noted when more than 2 L of isotonic saline has been infused. Recent data suggest that the saline-induced reduction of urinary excretion occurs only if the kidneys are set to retain fluid before the fluid therapy is initiated [21].…”

Section: Adverse Effects Of Crystalloid Fluidsmentioning

confidence: 99%

Adverse effects of crystalloid and colloid fluids

Hahn¹

2014

Anaesthesiol Intensive Ther

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Guidelines for infusion fluid therapy rarely take into account that adverse effects occur in a dose-dependent fashion. Adverse effects of crystalloid fluids are related to their preferential distribution to the interstitium of the subcutis, the gut, and the lungs. The gastrointestinal recovery time is prolonged by 2 days when more than 2 litres is administered. Infusion of 6-7 litres during open abdominal surgery results in poor wound healing, pulmonary oedema, and pneumonia. There is also a risk of fatal postoperative pulmonary oedema that might develop several days after the surgery. Even larger amounts cause organ dysfunction by breaking up the interstitial matrix and allowing the formation of lacunae of fluid in the skin and central organs, such as the heart. Adverse effects of colloid fluids include anaphylactic reactions, which occur in 1 out of 500 infusions. The possibility that hydroxyethyl starch causes kidney injury in patients other than those with sepsis is still unclear. For both crystalloid and colloid fluids, coagulation becomes impaired when the induced haemodilution has reached 40%. Coagulopathy is aggravated by co-existing hypothermia. Although oedema can occur from both crystalloid and colloid fluids, these differ in pathophysiology. To balance fluid-induced adverse effects, this review suggests that a colloid fluid is indicated when the infused crystalloid volume exceeds 3-4 litres, plasma volume support is still needed, and the transfusion of blood products is not yet indicated.

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“…In hospital care, a high urinary content of metabolic waste products is associated with a greater plasma volume expansion in response to crystalloid fluid[18] and a greater need for fluid optimization before abdominal surgery. [19] In hip fracture surgery, a high preoperative FRI has been associated with a greater rise in NGAL[7] and a greater number of postoperative complications.…”

Section: Discussionmentioning

confidence: 99%

Renal water conservation determines the increase in body weight after surgery: A randomized, controlled trial

Hahn

2017

Saudi J Anaesth

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Background:The present study was undertaken to identify factors that correlate with the gain in body weight after surgery.Methods:Twenty-one patients (median age of 49 years) were randomized to receive either Ringer × s acetate or 6% dextran 70 as their first infusion fluid during cholecystectomy or hysterectomy. Each patient's body weight was measured before the surgery and on the first postoperative morning. Blood and urine samples were analyzed for signs of stress, inflammation, and kidney injury. The fluid retention index (FRI), which reflects how strongly the kidneys excrete or retain fluid, was also calculated.Results:The body weight increased by a median of 0.4 kg in the crystalloid fluid group and by 1.0 kg in the colloid fluid group (maximum 2.5 kg, P < 0.01). This difference was due to less urinary excretion after surgery in the colloid group (P < 0.03). The increase in body weight did not correlate with the infused fluid volume, the plasma concentrations of C-reactive protein or cortisol, or the urinary excretion of albumin, cortisol, or neutrophil gelatinase-associated lipocalin. However, the body weight increased with the postoperative FRI score (r = 0.64; P < 0.003) and with the surgery-induced change in FRI score (r = 0.72; P < 0.002).Conclusion:How strongly the kidneys excrete or retain fluid, which can be assessed by urine sampling, was the strongest indicator of the increase in body weight during the day of surgery. The amount of fluid alone did not correlate with the gain in body weight.

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Isotonic saline in elderly men: an open‐labelled controlled infusion study of electrolyte balance, urine flow and kidney function

Cited by 30 publications

References 22 publications

Understanding volume kinetics

Understanding volume kinetics

Adverse effects of crystalloid and colloid fluids

Renal water conservation determines the increase in body weight after surgery: A randomized, controlled trial

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