scholarly journals Hyperchloremic metabolic acidosis during bipolar transurethral resection of the prostate: a report of two cases

2021 ◽  
Vol 49 (6) ◽  
pp. 030006052110244
Author(s):  
Ann Hee You ◽  
Ji Yoo Lee ◽  
Jeong-Hyun Choi ◽  
Mi Kyeong Kim
Keyword(s):  
Metabolic Acidosis ◽  
Transurethral Resection ◽  
Normal Saline ◽  
Isotonic Saline ◽  
Hemodynamic Instability ◽  
Acid Base ◽  
Electrolyte Disturbance ◽  
Irrigation Fluid ◽  
Laboratory Test Results ◽  
Hyperchloremic Metabolic Acidosis

Compared with monopolar transurethral resection of the prostate (TURP), which requires electrolyte-free irrigation fluid, normal saline can be used as the irrigation solution in bipolar and laser TURP. The risk of TURP syndrome and severe electrolyte disturbance is minimized when normal saline is used as the irrigation fluid. However, the use of isotonic saline also causes acid-base imbalance and electrolyte disturbance. We experienced two patients who developed hyperchloremic metabolic acidosis during bipolar TURP. After proper intervention, hemodynamic instability resolved, and laboratory test results normalized. Anesthesiologists must pay attention to acid-base and electrolyte status when rapid absorption of excessive isotonic solution is suspected, even during bipolar and laser TURP, which use normal saline as the irrigation fluid.

Changes in the plasma anion gap during chronic metabolic acid-base disturbances

1978 ◽  
Vol 235 (4) ◽  
pp. F291-F297 ◽  
Author(s):  
H. J. Adrogue ◽  
J. Brensilver ◽  
N. E. Madias
Keyword(s):  
Metabolic Acidosis ◽  
Metabolic Alkalosis ◽  
Protein Concentration ◽  
Anion Gap ◽  
Acid Base ◽  
Plasma Protein Concentration ◽  
Basic Premise ◽  
Hyperchloremic Metabolic Acidosis ◽  
Large Groups

A basic premise in the utilization of the plasma anion gap in the assessment of acid-base disorders is that this parameter remains constant during hyperchloremic metabolic acidosis and metabolic alkalosis. Experimental data under in vitro conditions, however, cast serious doubt on this premise. The purpose of the present study was to characterize the plasma anion gap, estimated as (Na + K) - Cl + HCO3), in two large groups of dogs with graded degrees of chronic, HCl-induced metabolic acidosis or chronic, diuretic-induced metabolic alkalosis. The data indicate that the plasma anion gap decreases significantly in HCl acidosis and increases significantly in metabolic alkalosis; the predicted mean anion gap in animals with a plasma bicarbonate concentration of 10, 21 (normal), and 40 meq/liter approximated 13, 18, and 26 meq/liter, respectively. The observed variation in the plasma anion gap is interpreted as originating mainly from directional changes in the net negative charge of plasma proteins; these changes result from the titration process secondary to the altered plasma acidity and, in the case of metabolic alkalosis, from the additional effect of an increased plasma protein concentration.

scholarly journals Experimental antegrade enema: effects on water, electrolyte and acid-base balances with different solutions

2007 ◽  
Vol 22 (5) ◽  
pp. 372-378 ◽  
Author(s):  
Laura Helman ◽  
José Luiz Martins ◽  
Djalma José Fagundes ◽  
Edward Esteves ◽  
Cirilo de Paula Lima ◽  
...  
Keyword(s):  
Metabolic Acidosis ◽  
Electrolyte Solution ◽  
Sodium Phosphate ◽  
Saline Solution ◽  
Isotonic Saline ◽  
Phosphate Solution ◽  
Acid Base ◽  
Glycerin Solution ◽  
Sodium Phosphate Solution ◽  
Antegrade Enema

PURPOSE: To study the effects on the water, electrolyte, and acid-base balances in rabbits submitted to antegrade enema with different solutions through appendicostomy. METHODS: Forty male New Zealand rabbits were submitted to appendicostomy, and distributed in 4 groups, according to the antegrade enema solution: PEG group, polyethylene glycol electrolyte solution (n=10); ISS group, isotonic saline solution (n=10); GS group, glycerin solution (n=10); SPS group, sodium phosphate solution (n=10). After being weighed, arterial blood gas analysis, red blood count, creatinine and electrolytes were measured at 4 times: preoperatively (T1); day 6 postop, before enema (T2); 4h after enema (T3); and 24h after T3 (T4). RESULTS: In PEG group occurred Na retention after 4h, causing alkalemia, sustained for 24h with HCO3 retention. In ISS group occurred isotonic water retention and hyperchloremic acidosis after 4h, which was partially compensated in 24h. GS group showed metabolic acidosis after 4h, compensated in 24h. In SPS group occurred hypernatremic dehydration, metabolic acidosis in 4h, and hypokalemia, hypocalcemia, hypomagnesemia, and metabolic alkalosis with partially compensated dehydration in 24h. CONCLUSIONS: All solutions used in this study caused minor alterations on water, electrolyte or acid-base balances. The most intense ones were caused by hypertonic sodium phosphate solution (SPS) and isotonic saline solution (ISS) and the least by polyethyleneglycol electrolyte solution (PEG) and glycerin solution 12% (GS).

scholarly journals The effect of balanced electrolyte solution versus normal saline in the prevention of hyperchloremic metabolic acidosis in diabetic ketoacidosis patients: a randomized controlled trial

2017 ◽  
Vol 26 (2) ◽  
pp. 134-40 ◽  
Author(s):  
Dita Aditianingsih ◽  
Anne S. Djaja ◽  
Yohanes W.H. George
Keyword(s):  
Metabolic Acidosis ◽  
Diabetic Ketoacidosis ◽  
Blood Sugar ◽  
Electrolyte Solution ◽  
Fluid Resuscitation ◽  
Normal Saline ◽  
Controlled Trial ◽  
Gas Analysis ◽  
Strong Ion Difference ◽  
Hyperchloremic Metabolic Acidosis

Background: In resuscitation, normal saline could cause hyperchloremic metabolic acidosis, while balanced electrolyte solution is a crystalloid fluid resembling blood plasma with lower chloride content. This study compared the effect of normal saline and balanced electrolyte solution Ringerfundin (BES) as the resuscitation fluid in diabetic ketoacidosis (DKA) patients. Parameters applied in this study were standard base excess (SBE) as resuscitation’s result indicator and strong ion difference (SID) to measure chloride’s influence in developing hyperchloremic acidosis.Methods: A prospective, randomized, single blind controlled trial was conducted at the Emergency Department of Cipto Mangunkusumo Hospital. Thirty subjects with blood sugar >250 mg/dl, arterial pH <7.35 mg/dl, and positive blood ketone were randomly allocated to receive either normal saline (NS) or RingerfundinÒ (BES) as the standardized resuscitation protocol. Data analysis was performed using the unpaired T-test and the Mann Whitney test to compare the SBE and the SID means between both groups. Additional parameters were the level of consciousness, blood sugar level, vital signs, blood gas analysis, lactate, electrolyte, and blood ketone.Results: The mean SID in the BES group was significantly greater than the NS group of all measurements (p<0.05). The BES group had significantly higher mean SBE compared to the NS group at 18 hours (-4.88±5.69 vs -9.68±5.64; p=0.009), 24 hours (-3.99±4.27 vs -8.7±5.35; p=0.023), and 48 hours (-4.06±4.11 vs -7.01±5.46; p=0.009). BES resulted in non-significant higher delta SBE and SID than NS. Additional parameters were not different between both groups.Conclusion: This study showed that fluid resuscitation of DKA patients with BES resulted in slightly but not significantly higher mean actual SBE and SID than NS. suggesting that BES as an alternative fluid resuscitation to prevent hyperchloremic acidosis in diabetic ketoacidosis patients was not superior to NS.

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