The Mechanism of the Acidosis Caused by Infusion of Saline Solution

Asano, Shingo; Kato, Eiichi; Yamauchi, M.; Ozawa, Yukio; Iwasa, Masako; Wada, Takao; Hasegawa, Hiroshi

doi:10.1016/s0140-6736(66)90248-0

Cited by 48 publications

(22 citation statements)

References 6 publications

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“…Both groups had negative base excesses at the beginning of the study and we assume this is a result of restriction in feeding overnight, induction of anaesthesia and instrumentation. During the study, there was continuous dilution of plasma bicarbonate, because blood plasma was removed by washing and the reinfused solutions contained no bicarbonate (13–15). In spite of this, there were no significant changes in acid–base parameters over the course of the study and we attribute this to the stable haemodynamic condition of the studied animals in the HES group and the metabolism of the bicarbonate precursors acetate and gluconate in the PBE group (16).…”

Section: Discussionmentioning

confidence: 99%

Haemodynamic, acid–base and electrolyte changes during plasma replacement with hydroxyethyl starch or crystalloid solution in young pigs

Sümpelmann

Schürholz

Marx

et al. 2000

Pediatric Anesthesia

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We investigated haemodynamic, acid-base and electrolyte changes during almost total plasma replacement with hydroxyethyl starch (HES) and physiological balanced electrolyte solution (PBE) by using a cell saver in ten young pigs. In the PBE group an additional 3550 (444) ml crystalloid solution [Mean (SD)] was infused over the course of the study in order to maintain pulmonary capillary wedge pressure. Plasma protein levels decreased in both groups and the colloid osmotic pressure increased in HES and decreased in PBE. At the end of the study, body weight [HES 10.4 (1), PBE 13.1 (1.4) kg, P < 0.01] and lactic acid concentration [HES 0.9 (0.3), PBE 2.9 (1. 3) mmol.l -1, P < 0.01] was higher and tissue oxygen delivery [HES 327 (22), PBE 89 (29) ml.min.m2, P < 0.01] was lower in the PBE group. There were only moderate acid-base changes in both groups, but at the end, anion gap was significant lower in HES. In conclusion, maintenance of colloid osmotic pressure close to the physiological range of infants seems to be advantageous during major paediatric surgery.

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Section: Discussionmentioning

confidence: 99%

Haemodynamic, acid–base and electrolyte changes during plasma replacement with hydroxyethyl starch or crystalloid solution in young pigs

Sümpelmann

Schürholz

Marx

et al. 2000

Pediatric Anesthesia

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“…Shires & Holman (1948) coined the term 'dilutional acidosis' and proposed that saline administration resulted in dilution of the body buffer base. Asano, Kato, Yamauchi, Ozawa, Iwasa, Wada & Hasegawa (1966) stated that the high chloride content of saline, in relation to that of the extracellular fluid, could have an acidifying effect. However, they demonstrated a fall in pH after infusion of solutions containing n o electrolytes.…”

Section: (B) Blood-gas and Acid-base Balancementioning

confidence: 99%

Some physiological and biochemical effects of the intravenous administration of five different electrolyte solutions in the dog

Rose

1979

Vet Pharm & Therapeutics

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Rose, R. J. Some physiological and biochemical effects of the intravenous administration of five different electrolyte solutions in the dog. 1. vet. Pharnacol. Therap. 2, 279-289, 1979.Some physiological effects of the intravenous administration of five different commercial electrolyte solutions were studied in healthy conscious dogs. Measurements were taken before, during and up to 3 h after fluid administration. The measurements included temperature, heart rate, respiratory rate, systolic and diastolic arterial pressure, central venous pressure, p02, pC02, pH, packed cell volume, haemoglobin, total plasma protein, sodium, potassium, chloride, bicarbonate, base excess and creatinine. There were no significant changes in temperature, respiratory rate, systolic pressure, p 0 2 or pCOz. All dogs showed a similar rise in central venous pressure and a fall in packed cell volume, haemoglobin and total plasma protein in response t o the fluid administration. Two saline solutions produced a metabolic acidosis, a fall in plasma potassium values and a rise in chloride. Administration of multi-electrolyte solutions resulted in the least disturbance in acid-base and electrolyte balance.

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“…Despite its physiological importance, chloride has captured little attention by the scientific community until recently (3) when chloride-rich solutions were associated with hyperchloremic metabolic acidosis (4, 5) and short-term mortality after non-cardiac surgery (6, 7). The precise mechanisms of hyperchloremic metabolic acidosis are somewhat controversial: 1) HCO 3 - dilution (8); 2) chloride as a key contributor to the decrease in strong ion difference influencing the dissociation of water with H + generation (Stewart approach) (9); and 3) the unbalanced dilution of the buffer system (HCO 3 - but not CO 2 ) (10). …”

Section: Introductionmentioning

confidence: 99%

Association of Hyperchloremia With Hospital Mortality in Critically Ill Septic Patients

Neyra

Canepa-Escaro²,

et al. 2015

Critical Care Medicine

187

164

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Objective Hyperchloremia is frequently observed in critically ill patients in the intensive care unit (ICU). Our study aimed to examine the association of serum chloride (Cl) levels with hospital mortality in septic ICU patients. Design Retrospective cohort study. Setting Urban academic medical center ICU. Patients ICU adult patients with severe sepsis or septic shock who had Cl measured on ICU admission were included. Those with baseline estimated glomerular filtration rate < 15 ml/min/1.73 m2 or chronic dialysis were excluded. Intervention: None. Measurements and Main Results Of 1940 patients included in the study, 615 (31.7%) had hyperchloremia (Cl ≥ 110 mEq/L) on ICU admission. All-cause hospital mortality was the dependent variable. Cl on ICU admission (Cl0), Cl at 72 h (Cl72), and delta Cl (ΔCl = Cl72 – Cl0) were the independent variables. Those with Cl0 ≥ 110 mEq/L were older and had higher cumulative fluid balance, base deficit, and sequential organ failure assessment scores. Multivariate analysis showed that higher Cl72 but not Cl0 was independently associated with hospital mortality in the subgroup of patients with hyperchloremia on ICU admission [adjusted odds ratio (OR) for Cl72 per 5 mEq/L increase = 1.27, 95% CI (1.02–1.59), P = 0.03]. For those who were hyperchloremic on ICU admission, every within-subject 5 mEq/L increment in Cl72 was independently associated with hospital mortality [adjusted OR for ΔCl 5 mEq/L = 1.37, 95% CI [1.11–1.69], P = 0.003]. Conclusions In critically ill septic patients manifesting hyperchloremia (Cl ≥110 mEq/L) on ICU admission, higher Cl levels and within-subject worsening hyperchloremia at 72 h of ICU stay were associated with all-cause hospital mortality. These associations were independent of base deficit, cumulative fluid balance, acute kidney injury, and other critical illness parameters.

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The Mechanism of the Acidosis Caused by Infusion of Saline Solution

Cited by 48 publications

References 6 publications

Haemodynamic, acid–base and electrolyte changes during plasma replacement with hydroxyethyl starch or crystalloid solution in young pigs

Haemodynamic, acid–base and electrolyte changes during plasma replacement with hydroxyethyl starch or crystalloid solution in young pigs

Some physiological and biochemical effects of the intravenous administration of five different electrolyte solutions in the dog

Association of Hyperchloremia With Hospital Mortality in Critically Ill Septic Patients

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