Plasma-Lyte 148: A clinical review

Abstract

AIMTo outline the physiochemical properties and specific clinical uses of Plasma-Lyte 148 as choice of solution for fluid intervention in critical illness, surgery and perioperative medicine.METHODSWe performed an electronic literature search from Medline and PubMed (via Ovid), anesthesia and pharmacology textbooks, and online sources including studies that compared Plasma-Lyte 148 to other crystalloid solutions. The following keywords were used: “surgery”, “anaesthesia”, “anesthesia”, “anesthesiology”, “anaesthesiology”, “fluids”, “fluid therapy”, “crystalloid”, “saline”, “plasma-Lyte”, “plasmalyte”, “hartmann’s”, “ringers” “acetate”, “gluconate”, “malate”, “lactate”. All relevant articles were accessed in full. We summarized the data and reported the data in tables and text.RESULTSWe retrieved 104 articles relevant to the choice of Plasma-Lyte 148 for fluid intervention in critical illness, surgery and perioperative medicine. We analyzed the data and reported the results in tables and text.CONCLUSIONPlasma-Lyte 148 is an isotonic, buffered intravenous crystalloid solution with a physiochemical composition that closely reflects human plasma. Emerging data supports the use of buffered crystalloid solutions in preference to saline in improving physicochemical outcomes. Further large randomized controlled trials assessing the comparative effectiveness of Plasma-Lyte 148 and other crystalloid solutions in measuring clinically important outcomes such as morbidity and mortality are needed.

The effects of Plasma-Lyte 148 solution on blood coagulation

“…On the other hand, the electrolyte composition of Plasma-Lyte 148 more closely reflects the constituents of human plasma than isotonic saline, and is hence considered a more-physiologic solution [ 9 ]. Therefore, Plasma-Lyte 148 has important advantages over isotonic saline, namely, its ability to maintain the acid-base balance, even when administered in large volumes [ 6 , 8 , 17 ].…”

“…Plasma-Lyte 148 is a balanced crystalloid that contains sodium, potassium, chloride, and magnesium, but not calcium. Because of its ‘physiologic’ or ‘balanced’ formulation, Plasma-Lyte 148 is less likely than other crystalloid solutions, such as Hartmann's solution or isotonic saline (NaCl), to lead to dilutional or hyperchloremic acidosis [ 6 – 9 ].…”

Study Protocol for Better Evidence for Selecting Transplant Fluids (BEST-Fluids): a pragmatic, registry-based, multi-center, double-blind, randomized controlled trial evaluating the effect of intravenous fluid therapy with Plasma-Lyte 148 versus 0.9% saline on delayed graft function in deceased donor kidney transplantation

“…Moreover, these results are not necessarily generalizable to the typical deceased donor kidney transplant setting, as two thirds of studies involved recipients of living donor kidneys (at very low risk of DGF), and trial fluids were only given intraoperatively in relatively low volumes. However, in a recent blinded randomized trial conducted in deceased donor kidney transplant recipients who received fluid volumes more typical of clinical practice (median 6-7 L from surgery until post-operative day two), the incidence of hyperkalemia was significantly lower with Plasmalyte compared with 0.9% saline, and a post-hoc analysis showed improvements in several measures of graft function [25]. Definitive trials in high-risk populations, including deceased donor kidney transplant recipients, are therefore still required.…”

Plasma-Lyte 148 and Plasma-Lyte 148 + 5% glucose compatibility with commonly used critical care drugs

“…It has also led to improved acid-base status and less hyperchloremia at 24 h post injury in trauma patients, when compared to 0.9% sodium chloride [18]. Therefore, and also in accordance with the literature review by Weinberg et al, it does appear that the use of such solutions is preferable compared to 0.9% sodium chloride in improving physicochemical outcomes; however, more data is required [12,19].…”

“…Balanced fluids have a composition reflecting that of extracellular fluid and are designed to minimise any metabolic disturbances. Plasma-Lyte 148 is an example, being an isotonic crystalloid solution which is physiologically similar to extracellular fluid composition in terms of both osmolarity (294 mOsm) and electrolyte composition [12,13]. Acetate and gluconate are also present, acting as bicarbonate precursors which are metabolised in vivo [14].…”