Metabolic and Hemodynamic Effects of Hypertonic Solutions: Sodium-Lactate Versus Sodium Chloride Infusion in Postoperative Patients

Abstract

Although hypertonic saline has been proposed as an intravenous resuscitation fluid, the beneficial effects of the sodium load are associated with potentially deleterious effects of chloride. Since the physiological lactate anion is well metabolized, hypertonic lactate solution could represent an interesting alternative. The aim of this study was to compare metabolic and hemodynamic effects of hypertonic infusion of sodium lactate versus sodium chloride in three groups of surgical patients who underwent elective coronary artery bypass grafting (CABG). Hypertonic lactate solution was infused to patients 14 to 16 h after surgery either involving a cardiopulmonary bypass (CPB-Lac, n = 20) or on-off pump (OPCAB-Lac, n = 20), whereas the third group consisted of patients undergoing cardiopulmonary bypass but receiving hypertonic saline solution (CPB-NaCl, n = 20). An equal fluid and sodium load (2.5 mL/2.5 mmol x kg(-1)) was infused in all patients over 15 min. Plasma glucose and sodium increased after infusion in the three groups, but the changes, although significant, were small. As expected, lactate rose only in CPB-Lac and OPCAB-Lac groups, the changes being more marked in CPB-Lac, indicating a slower lactate metabolism in this group compared with OPCAB-Lac. Although both solutions produced significant increases in cardiac index and oxygen delivery, there was a significant decrease in oxygen extraction only in groups receiving sodium lactate (CPB-Lac and OPCAB-Lac) and not in CPB-NaCl. Finally, hypertonic NaCl infusion induced a modest, although significant, decrease in arterial pH and bicarbonate, whereas hypertonic lactate infusion increased these two parameters in both CPB-Lac and OPCAB-Lac. This study demonstrates that hypertonic lactate infusion is safe and well tolerated in patients undergoing elective cardiac surgery.

Induction of Pluripotent Stem Cell-Derived Cardiomyocyte Toxicity by Supernatant of Long Term-Stored Red Blood Cells in Vitro

“…Clinically significant hyperkalemia can result following the infusion of a number of RBCs units, especially in infants and small children. Whether hyperlactatemia itself has an effect on cellular function remains unclear, but in vitro studies suggested that lactate has depressive effects on cardiovascular function, and can facilitate cardiac arrhythmias and other adverse effects [31, 32]. In order to study whether K and LA in the SSRBCs have toxic effects on hiPS-CMs, we prepared LA solution, K solution and a mixture of K and LA solution to evaluate their effects on hiPS-CMs, respectively.…”

Lactic Acidosis: Current Treatments and Future Directions

“…60 However, infusion of large amounts of sodium lactate, which increased blood lactate levels up to 15 mEq/L, did not depress cardiac output in patients following heart transplantation. 61 Further studies are necessary to examine the potential merits of lactate removal.…”

Treatment of lactic acidosis: Appropriate confusion

“…Studies on infusion of lactate solutions to postoperative patients was shown to be safe. 55 Also, the fact that lactate generation in states of respiratory alkalosis, stress, or altered carbohydrate metabolism without sepsis is not associated with worse outcomes supports the fact that lactic acid alone may not be maladaptive.…”