scholarly journals Intra-operative intravascular effect of the difference in colloid solutions during acute normovolemic hemodilution

2021 ◽  
Vol 7 (1) ◽  
Author(s):  
Yoko Midorikawa ◽  
Junichi Saito ◽  
Masato Kitayama ◽  
Kentaro Toyooka ◽  
Kazuyoshi Hirota
Keyword(s):  
Blood Transfusion ◽  
Blood Volume ◽  
Acute Normovolemic Hemodilution ◽  
Acid Base Balance ◽  
Acid Base ◽  
Serum Electrolytes ◽  
Ringer’S Lactate ◽  
Base Balance ◽  
Normovolemic Hemodilution ◽  
The Difference

Abstract Background Acute normovolemic hemodilution (ANH) is used to reduce the risk of peri-operative allogeneic blood transfusion. Although crystalloid and/or colloid solutions have been used for volume replacement during ANH, no studies have examined the differences among solutions on the volume status, electrolytes, acid-base balance, and hemodynamic status during surgery with ANH. Methods We retrospectively compared the effect of Ringer’s lactate with 3% dextran-40 (Saviosol®, DEX group) and 6% hydroxyethyl starch 130/0.4 in 0.9% sodium chloride (Voluven®, HES group) on blood hemoglobin serum electrolytes and estimated blood volume before induction of anesthesia (baseline), after ANH and after blood transfusion following surgery in patients undergoing open gynecological surgery (n = 111 and 67, respectively). The primary outcomes were the changes in hemoglobin and electrolytes after ANH. Results There were no differences in hemoglobin or electrolytes between the two groups at baseline. Postoperative hemoglobin was significantly higher (11.0 ± 1.5 g/dL vs 9.9 ± 1.3 g/dL) (mean ± SD) in the DEX group than in the HES group (p = 0.03). Postoperative potassium was significantly decreased from the baseline both in the DEX group (137.9 ± 2.5 mmol/L vs 136.3 ± 2.7 mmol/L) and in the HES group (138.3 ± 2.0 mmol/L vs 137.8 ± 2.5 mmol/L) (p < 0.001 for both); however, it was significantly higher than in the DEX group after surgery (p < 0.001). Estimated blood volume after surgery was significantly increased after ANH in both groups; however, it was larger in the HES group than in the DEX group. Conclusions Postoperative hemoglobin and potassium were significantly higher, and estimated blood volume was significantly smaller in the DEX than in the HES group.

scholarly journals Effects of different plasma expanders on rats subjected to severe acute normovolemic hemodilution

2020 ◽  
Vol 7 (1) ◽  
Author(s):  
Guo-Xing You ◽  
Bing-Ting Li ◽  
Zhen Wang ◽  
Quan Wang ◽  
Ying Wang ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Hydroxyethyl Starch ◽  
The Other ◽  
Acute Normovolemic Hemodilution ◽  
Acid Base Balance ◽  
Acid Base ◽  
Base Balance ◽  
Normovolemic Hemodilution ◽  
Plasma Expanders ◽  
Low Shear

Abstract Background Plasma expanders are widely used for acute normovolemic hemodilution (ANH). However, existing studies have not focused on large-volume infusion with colloidal plasma expanders, and there is a lack of studies that compare the effects of different plasma expanders. Methods The viscosity, hydrodynamic radius (Rh) and colloid osmotic pressure (COP) of plasma expanders were determined by a cone-plate viscometer, Zetasizer and cut-off membrane, respectively. Sixty male rats were randomized into five groups with Gelofusine (Gel), Hydroxyethyl Starch 200/0.5 (HES200), Hydroxyethyl Starch 130/0.4 (HES130), Hydroxyethyl Starch 40 (HES40), and Dextran40 (Dex40), with 12 rats used in each group to build the ANH model. ANH was performed by the withdrawal of blood and simultaneous infusion of plasma expanders. Acid-base, lactate, blood gas and physiological parameters were detected. Results Gel had a lower intrinsic viscosity than HES200 and HES130 (P < 0.01), but at a low shear rate in a mixture of colloids, red cells and plasma, Gel had a higher viscosity (P < 0.05 or P < 0.01, respectively). For hydroxyethyl starch plasma expanders, the COP at a certain concentration decreases from 11.1 mmHg to 6.1 mmHg with the increase of Rh from 10.7 nm to 20.2 nm. A severe ANH model, with the hematocrit of 40% of the baseline level, was established and accompanied by disturbances in acid-base, lactate and blood gas parameters. At the end of ANH and 60 min afterward, the Dex40 group showed a worse outcome in maintaining the acid-base balance and systemic oxygenation compared to the other groups. The systolic blood pressure (SBP), diastolic blood pressure (DBP), and mean arterial pressure (MAP) decreased significantly in all groups at the end of ANH. The DBP and MAP in the Dex40 group further decreased 60 min after the end of ANH. During the process of ANH, the Dex40 group showed a drop and recovery in SBP, DBP and MAP. The DBP and MAP in the HES200 group were significantly higher than those in the other groups at some time points (P < 0.05 or P < 0.01). Conclusion Gel had a low intrinsic viscosity but may increase the whole blood viscosity at low shear rates. Rh and COP showed a strong correlation among hydroxyethyl starch plasma expanders. Dex40 showed a worse outcome in maintaining the acid-base balance and systemic oxygenation compared to the other plasma expanders. During the process of ANH, Dex40 displayed a V-shaped recovery pattern for blood pressure, and HES200 had the advantage in sustaining the DBP and MAP at some time points.

scholarly journals Red blood transfusion in preterm infants: changes in glucose, electrolytes and acid base balance

2012 ◽  
Vol 6 (1) ◽  
pp. 36 ◽  
Author(s):  
Reem Ibrahim ◽  
Dina Mohamed ◽  
Shereen Abdelghaffar ◽  
Yasmeen Mansi
Keyword(s):  
Blood Transfusion ◽  
Preterm Infants ◽  
Acid Base Balance ◽  
Acid Base ◽  
Base Balance

scholarly journals P0601SAFETY AND EFFICACY OF INTRAVENOUS ADMINISTRATION OF RINGER'S LACTATE VERSUS NORMAL SALINE 0.9% SOLUTION IN PATIENTS WITH ACUTE KIDNEY INJURY AND ESTABLISHED CHRONIC KIDNEY DISEASE

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Marios Papasotiriou ◽  
Adamantia Mpratsiakou ◽  
Georgia Georgopoulou ◽  
Lamprini Balta ◽  
Paraskevi Pavlakou ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Acute Kidney Injury ◽  
Renal Function ◽  
Kidney Injury ◽  
Acid Base Balance ◽  
Acid Base ◽  
Safety And Efficacy ◽  
Ringer’S Lactate ◽  
Base Balance ◽  
The Mean

Abstract Background and Aims Crystalline solutions, such as normal saline 0.9% (N/S 0.9%) and Ringer's Lactate (L/R), are readily administered for increasing plasma volume. Despite the utility of administering N/S 0.9% to hypovolemic patients, the dose of 154 mmol of sodium (Na) contained in 1 L exceeds the recommended daily dose increasing the risk of sodium overload and hyperchloremic metabolic acidosis. In contrast, L/R solution has the advantage of lower Na content, significantly less chlorine and contains lactates which may be advantageous in patients with significant acidemia such as patients with acute kidney injury (AKI) and chronic kidney disease (CKD). The aim of the present study is to investigate the safety and efficacy of administration of L/R versus N/S 0.9% in patients with prerenal AKI and established CKD. Method The study included adult patients with known CKD stage II to V without need for dialysis, with prerenal AKI (AKIN Stage I to III Criteria). Patients with other forms of AKI as well as hypervolemia, heart congestion or hyperkalemia (serum K&gt;5.5 meq/l) were excluded from the study. Patients were randomized in 1:1 ratio to receive intravenously either N/S 0.9% or L/R solution at a dose of 20 ml/kg body weight/day. We studied kidney function (eGFR: CKD-EPI) and response to treatment at discharge and at 30 days after discharge, duration of hospitalization, improvement in serum bicarbonate levels (HCO3), acid-base balance, serum potassium levels and the need for dialysis. Results The study included 26 patients (17 males) with a mean age of 59.1 ± 16.1 years. Thirteen patients received treatment with N/S 0.9% and the rest with L/R solution. Baseline demographic and clinical characteristics at hospital admission and historical data did not show any significant differences in both groups of patients. Renal function at the onset of AKI did not show significant differences between the two groups (16.4 ± 5.8 vs 16.9 ± 5.7 ml/min/1.73 m2, p=ns, treatment with N/S and L/R respectively). The mean volume of solutions received by the two groups (N/S 0.9% 1119 ± 374 vs L/R 1338 ± 364 ml/day, p=ns) as well as the mean total volume of liquids received per day, did not differ significantly (2888 ± 821 vs 3069 ± 728 ml/d, p=ns). Patients treated with L/R were discharged 1 day earlier than patients treated with N/S (5.2 ± 3.2 vs 6.2 ± 4.9 days of hospitalization, p=ns). Renal function improvement during hospitalization and 30 days after discharge did not differ significantly between the two groups. Patients that received L/R showed a higher increase in plasma HCO3 (ΔHCO3) concentration at discharge than those that received N/S 0.9% (4.9 ± 4.1 vs 2.46 ± 3.7 meq/l, p=ns) and pH increase (ΔpH) was slightly higher in those that received L/R solution (0.052 ± 0.066 vs 0.023 ± 0.071, p=ns). Patients treated with N/S 0.9% showed a greater decrease in serum potassium (ΔK) at discharge compared to those treated with L/R (-0.39 ± 1.03 vs -0.17 ± 0.43 meq/l, p=ns, respectively). No patient received acute dialysis treatment. Conclusion Administration of L/R solution as a hydration treatment to patients with prerenal AKI and established CKD is not inferior concerning safety and efficacy to N/S 0.9% solution. In addition, L/R administration seems to marginally improve acid-base balance in this specific group of patients.

Effect of Marcha Exercise on Serum Electrolytes and Acid–Base Balance in Mangalarga Marchador Horses

2017 ◽  
Vol 49 ◽  
pp. 108-112 ◽  
Author(s):  
Laura Pereira Martins ◽  
Paula Alessandra Di Filippo ◽  
Marcos Aurélio Dias Meireles ◽  
Rodrigo Menezes Salles Peçanha ◽  
Luciana de Macêdo Mello ◽  
...  
Keyword(s):  
Acid Base Balance ◽  
Acid Base ◽  
Serum Electrolytes ◽  
Base Balance

scholarly journals Physical exercise on serum electrolytes and acid base balance in Mangalarga Marchador horses submitted to cavalcade of 4, 8 and 20km

2017 ◽  
Vol 47 (5) ◽  
Author(s):  
Jessica Martins Linhares ◽  
Paula Alessandra Di Filippo ◽  
Paulo Moreira Bogossian ◽  
Rafael Vianna Barbosa de Almeida Guerra ◽  
Sebastian Ricardo Bustamante Bustamante ◽  
...  
Keyword(s):  
Partial Pressure ◽  
Base Excess ◽  
Venous Blood ◽  
Acid Base Balance ◽  
Acid Base ◽  
Electrolyte Disorders ◽  
Serum Electrolytes ◽  
Animal Blood ◽  
Blood Samples ◽  
Base Balance

ABSTRACT: Acid-base and electrolyte disorders have been described in horses associated during and after exercise. The aim of the present study was to evaluate the effect of cavalcade competition on the acid-base and hydroelectrolytic balance in Mangalarga Marchador horses. For this purpose, 15 geldings, 6.2 ± 1.2 years old and clinically healthy, were distributed into three groups of five animals each. Horses were trained to take part in cavalcade competitions. Animals were submitted to cavalcade along 4km (G4), 8km (G8), and 20km (G20) at mean speeds of 15km h-1, 12km h-1, and 12km h-1, respectively. From each horse, venous blood samples were collected before exercise (T0) and immediately after (T1) cavalcade. Bicarbonate ion (HCO3-), pH, partial pressure of carbon dioxide (pCO2), partial pressure of oxygen (pO2), base excess (BE), hematocrit (Hct), sodium (Na+), potassium (K+), chloride (Cl-) and lactate were determined. The variables pH, pO2 and pCO2 were corrected in function of rectal temperature of each animal. Blood samples were analyzed for acid-base balance, as well as biochemical and electrolyte parameters using an i-STAT analyzer. Significant (P<0.05) increase in Hct, Na+, pH, HCO3 - and BE were observed after cavalcade in G20 group. Decrease (P<0.05) in K+ and Cl- were also observed in G20 animals after cavalcade (T1). Changes in the acid-base balance and hydroelectrolytic profile of the Mangalarga Marchador after cavalcade of 20km resulted in hypochloremic metabolic alkalosis. The 20km cavalcade induced significant hydroelectrolytic and acid-base imbalances in Mangalarga Marchador horses.

Acid–Base Changes Caused by 5% Albumin versus  6% Hydroxyethyl Starch Solution in Patients Undergoing Acute Normovolemic Hemodilution

2000 ◽  
Vol 93 (5) ◽  
pp. 1174-1183 ◽  
Author(s):  
Markus Rehm ◽  
Victoria Orth ◽  
Stefan Scheingraber ◽  
Uwe Kreimeier ◽  
Heinz Brechtelsbauer ◽  
...  
Keyword(s):  
Metabolic Acidosis ◽  
Blood Volume ◽  
Hydroxyethyl Starch ◽  
Strong Ion Difference ◽  
Albumin Concentration ◽  
Acute Normovolemic Hemodilution ◽  
Starch Solution ◽  
Acid Base ◽  
Normovolemic Hemodilution ◽  
Chloride Concentrations

Background Preoperative acute normovolemic hemodilution (ANH) is an excellent model for evaluating the effects of different colloid solutions that are free of bicarbonate but have large chloride concentrations on acid-base equilibrium. Methods In 20 patients undergoing gynecologic surgery, ANH to a hematocrit of 22% was performed. Two groups of 10 patients each were randomly assigned to receive either 5% albumin or 6% hydroxyethyl starch solutions containing chloride concentrations of 150 and 154 mm, respectively, during ANH. Blood volume (double label measurement of plasma and red cell volumes), pH, Paco2, and serum concentrations of sodium, potassium, chloride, lactate, ionized calcium, phosphate, albumin, and total protein were measured before and 20 min after completion of ANH. Strong ion difference was calculated as serum sodium plus serum potassium minus serum chloride minus serum lactate. The amount of weak plasma acid was calculated using a computer program. Results After ANH, blood volume was well maintained in both groups. ANH caused slight metabolic acidosis with hyperchloremia and a concomitant decrease in strong ion difference. Plasma albumin concentration decreased after hemodilution with 6% hydroxyethyl starch solution and increased after hemodilution with 5% albumin solution. Despite a three-times larger decrease in strong ion difference after ANH with 6% hydroxyethyl starch solution, the decrease in pH was nearly the same in both groups. Conclusions ANH with 5% albumin or 6% hydroxyethyl starch solutions led to metabolic acidosis. A dilution of extracellular bicarbonate or changes in strong ion difference and albumin concentration offer explanations for this type of acidosis.

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