Crystalloid strong ion difference determines metabolic acid-base change during in vitro hemodilution

Morgan, Thomas J.; Venkatesh, Balasubramanian; Hall, Jeremy Peter

doi:10.1097/00003246-200201000-00022

Cited by 98 publications

(58 citation statements)

References 23 publications

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“…Although these observations lend plausibility to the hypothesis that the chloride composition of IV fluids can alter their effect on GFR, it is unclear whether use of 0.9% saline increases the risk of development or progression of renal dysfunction. In particular, because oxygen is offloaded to the tissues more effectively as pH falls (as a result of the Bohr effect [42]) and chloride-rich solutions are acidifying [43], it is unclear whether 0.9% saline impairs or enhances renal tissue oxygen delivery compared to buffered crystalloids. There are no published clinical trials specifically comparing different crystalloids in the setting of AKI and although a recent meta-analysis suggested that the use of high chloride fluids was associated with a 60% increase in the risk of developing acute kidney injury [44], the statistical significance of this observation was dependent on the findings of a single before-and-after study [45].…”

Section: Crystalloid Solutionsmentioning

confidence: 99%

Fluid management in acute kidney injury

et al. 2017

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Acute kidney injury (AKI) and fluids are closely linked through oliguria, which is a marker of the former and a trigger for administration of the latter. Recent progress in this field has challenged the physiological and clinical rational of using oliguria as a trigger for the administration of fluid and brought attention to the delicate balance between benefits and harms of different aspects of fluid management in critically ill patients, in particular those with AKI. This narrative review addresses various aspects of fluid management in AKI outlining physiological aspects, the effects of crystalloids and colloids on kidney function and the effect of various resuscitation and de-resuscitation strategies on the course and outcome of AKI.

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Section: Crystalloid Solutionsmentioning

confidence: 99%

Fluid management in acute kidney injury

et al. 2017

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“…Volume resuscitation also reduces the weak acid concentration, thereby moderating the acidosis. One ex vivo study concluded that administration of a solution with an SID of approximately 24 mEq/L will have a neutral effect on the pH as blood is progressively diluted [112].…”

Section: Iatrogenic Acidosismentioning

confidence: 99%

Acid–Base Physiology

Agarwal

Liepert

2014

Surgical Metabolism

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“…Somit war auch in diesem Fall die Abnahme der SID als wahrscheinlich entscheidender Mechanismus für die Entstehung der Acidose beim TURP-Syndrom identifiziert. Dementsprechend ist für die Entwicklung einer Acidose bei Infusion einer wässri-gen Lösung die SID der entsprechenden Lösung maßgebend [60]. Bei 0,9%iger NaCl-Lösung,wie auch bei freiem Wasser beträgt diese 0 meq/l, und nicht rund 40 meq/l, wie im menschlichen Plasma (⊡ Abb.…”

Section: Der Anaesthesist 4 · 2004 352unclassified

Das Stewart-Modell

et al. 2004

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About twenty years ago, Peter Stewart had already published his modern quantitative approach to acid-base chemistry. According to his interpretations, the traditional concepts of the mechanisms behind the changes in acid-base balance are considerably questionable. The main physicochemical principle which must be accomplished in body fluids, is the rule of electroneutrality. There are 3 components in biological fluids which are subject to this principle: a)Water, which is only in minor parts dissociated into H+ and OH-, b)"strong", i.e. completely dissociated, electrolytes, which thus do not interact with other substances, and body substances, such as lactate, and c)"weak", i.e. incompletely dissociated, substances. Peter Stewart strictly distinguished between dependent and independent variables and thus indeed described a new order of acid-base chemistry. The 3 dependent variables (bicarbonate concentration [Bic(-)], pH, and with this also hydrogen ion concentration [H(+)]) can only change if the 3 independent variables allow this change. These 3 independent variables are: 1. Carbon dioxide partial pressure, 2.the total amount of all weak acids ([A-] (Stewart called these ATOT), and 3.strong ion difference (SID). [A(-)] can be calculated from the albumin (Alb) and the phosphate concentration (Pi): [A(-)]=[Alb x (0.123 x pH - 0.631)] + [Pi x (0.309 x pH - 0.469)]. An apparent SID (or "bedside" SID) can be calculated using measurable ion concentrations: SID=[Na(+)] + [K(+)] - [Cl(-)]-lactate. Regarding the metabolic disturbances of acid-base chemistry, according to Stewart's terminology, changes in pH, [H(+)], and [Bic(-)] are only possible if either SID or [A(-)] itself changes. If, for example, SID decreases (e.g. in case of hyperchloremia), this increase in independent negative charges leads to a decrease in dependent negative charges in terms of [Bic(-)] resulting in acidosis (and vice versa). Therefore, according to Stewart, the decrease in SID during hyperchloremic acidosis results from the increase in serum chloride concentration and is the causal mechanism behind this acidosis. Contrary for example, a decrease in [A(-)] (e. g. during hypoalbuminemia) leads to an increase in [Bic(-)] and therefore to an alcalosis (and vice versa). Thus, by Stewart's approach, completely new acid-base disturbances, like "hyperchloremic acidosis" or "hypoalbuminemic alcalosis" (which, of course, can also exist in combination) can be detected, which had been unrecognised by the classic acid-base concepts. Consequently, Stewart's analysis can lead to a better understanding of the mechanisms behind the changes in acid-base balance.

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Crystalloid strong ion difference determines metabolic acid-base change during in vitro hemodilution

Cited by 98 publications

References 23 publications

Fluid management in acute kidney injury

Fluid management in acute kidney injury

Acid–Base Physiology

Das Stewart-Modell

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