A velocidade de infusão da solução poli-iônica intravenosa contendo 84mEq/L de lactato determina a intensidade do efeito alcalinizante em equinos

Abstract

RESUMO O objetivo deste trabalho foi verificar os efeitos da solução poli-iônica intravenosa contendo 84mEq/L de lactato (L84) sobre os equilíbrios hidroeletrolítico e ácido-base de equinos, quando administrada de forma rápida ou lenta. Cinco equinos sadios adultos receberam a infusão contínua intravenosa da L84, em volume correspondente a 10% do peso corporal, em duas ocasiões: a) infusão rápida (16,66mL/kg/h) durante seis horas; b) infusão lenta (8,33mL/kg/h) durante 12 horas. Amostras de sangue venoso foram colhidas ao início da infusão (hora zero) e três, seis, nove, 12 e 24 horas após, e amostras de urina nas horas zero, seis, 12 e 24. Determinaram-se pH (sanguíneo e urinário), pCO2, HCO3 -, BE, PPT, lactato L, Na+, K+, Cl-, AG, SID, Atot, VVP, densidade urinária e excreções fracionadas urinárias de lactato L, Na+, K+ e Cl-. A L84 provoca efeito alcalinizante iatrogênico de menor magnitude quando administrada de forma lenta, porque os mecanismos renais, atuantes durante o período de infusão, promovem a correção gradativa do desequilíbrio. Pode-se concluir que a infusão de forma lenta da solução L84 em equinos é recomendável nos casos em que se suspeite de acidose metabólica e não seja possível quantificar o grau do desequilíbrio.

Iatrogenic alkalosis in goats with the use of intravenous electrolyte solution containing 84 mEq/L of lactate

“…The decrease in K + FE during infusion, with return to original values at 4.5 h, occurred in response to hemodilution, hyperhydration, and the need to excrete excess liquid in the studied animals. This result is different from that observed in studies in sheep (FLAIBAN, 2010) and horses (PINTO et al, 2018), which showed elevated K + excretion, and in calves (JUNQUEIRA et al, 2015), which did not show any variation.…”

“…This result is different from that observed in healthy sheep and calves, which showed no difference in L-lactate FE before, during, or after the solution infusions (FLAIBAN, 2010;JUNQUEIRA et al, 2015). Healthy horses, when receiving L84 solution at a speed of 16.66 mL/ kg/h, showed an increase in L-lactate FE at the end of the infusion, with a return to baseline values 6 h after the end of the infusion (PINTO et al, 2018).…”

“…Thus, L84 administration resulted in a reduction in chloremia, which increased SID 3 and consequently generated iatrogenic metabolic alkalosis. The increase in SID 3 at the end of L84 infusion was also demonstrated in healthy sheep, calves, and horses (FLAIBAN, 2010;JUNQUEIRA et al, 2015;PINTO et al, 2018). The effective SID 3 of the L84 solution is equivalent to its lactate concentration (84 mEq /L).…”

“…Another distinction from the previous studies is that, unlike sheep and calves that were followed for only 2 and 2.5 h after the end of the infusion, the goats were followed for a longer period of time, which allowed us to verify the time in which the iatrogenic imbalance was reversed. Another study, using the L84 solution in healthy horses, with different infusion rates (16.66 or 8.33 mL/kg/h), proved the alkalizing capacity of the solution in this species; however, it was revealed that its magnitude is dependent on the infusion rate (PINTO et al, 2018).…”

“…In search of a safer alternative for the treatment of metabolic acidosis, an electrolyte solution containing 84 mEq/L of lactate was developed, and its alkalizing effect was verified in healthy sheep (FLAIBAN, 2010), calves (JUNQUEIRA et al, 2015), and horses (PINTO et al, 2018). This solution has been shown to be effective in correcting metabolic acidosis in sheep with ARLA (FLAIBAN, 2010), calves with diarrhea (JUNQUEIRA, 2012), and horses with hyperchloremic acidosis (ROMÃO et al, 2017).…”