Effects of Plasma-lyte A, lactated Ringer's, and normal saline on acid-base status and intestine injury in the initial treatment of hemorrhagic shock

Wang, Ying; W, Guo; Gao, Dawei; You, Guoxiang; Wang, Bo; Gan, Chunfang; Zhao, Lei; Zhao, Jingxiang; Zhou, Hong

doi:10.1016/j.ajem.2016.10.007

Cited by 7 publications

(2 citation statements)

References 24 publications

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“…In further support of bicarbonate Ringer’s solution, it is impressive to recognize that the metabolic rate of sodium bicarbonate is 6 times greater than lactic acid, which would reduce the metabolic burden to the liver. [ 29 ] Concordant with the present study, bicarbonate Ringer’s solution has been effective in the early resuscitation of patients with severe multiple injuries and traumatic shock, improving coagulation function and lactic acid metabolism, thereby reducing the risk of related complications and improving patient outcome. [ 30 ] This may be related to the HCO3− buffer system that can neutralize acidity without increasing lactic acid.…”

Section: Discussionsupporting

confidence: 83%

Hemorrhagic, hypovolemic shock resuscitated with Ringer’s solution using bicarbonate versus lactate: A CONSORT-randomized controlled study comparing patient outcomes and blood inflammatory factors

et al. 2022

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Background: Isotonic crystalloids are the preferred solution for the initial clinical management of patients with multiple trauma, among which lactated Ringer's solution and normal saline are the most widely used, but both have clinical limitations. Bicarbonated Ringer's solution (BRS), which provides physiological levels of bicarbonate ions and electrolyte ions, can be used to supplement missing extracellular fluid and correct metabolic acidosis.Methods: A prospective, randomized controlled study enrolled 63 patients with traumatic hepatic rupture and hemorrhagic shock. They were randomly assigned to the Bicarbonated group (n = 33) or the Control group (n = 30), which received restrictive fluid resuscitation with sodium bicarbonate Ringer's solution or sodium lactate Ringer's solution, respectively. The levels of interleukin (IL)-6, tumor necrosis factor (TNF)-α, arterial blood lactic acid and potential of hydrogen (pH) were measured prior to, 1, 3, 24, and 72 hours following resuscitation. The primary outcomes were patient survival, shock-related complications, and comparison of the inflammatory factors.Results: The incidence of complications in the Bicarbonated group was significantly lower than in the Control group (15.15% vs 40.0%; P < .05). The intensive care unit length of stay and mechanical ventilation time in the Bicarbonated group were significantly shorter than in the Control group (all P < .01). The levels of IL-6 and TNF-α in the Bicarbonated group were significantly lower 1 hour following resuscitation than prior to resuscitation (P < .01), whereas these levels in the Control group were increased following 1h of resuscitation as compared with before resuscitation (P < .01). Following resuscitation, the levels of IL-6, TNF-α and lactate in the Bicarbonated group were significantly lower than in the Control group (P < .01). Moreover, in the Bicarbonated group, the lactic acid level decreased and the pH value increased significantly following resuscitation, whereas there was no difference in lactic acid levels and pH value between pre-and 1 hour post-resuscitation in the Control group (P > .05). Conclusion:The shock-related complications were dramatically reduced from using BRS in these patients. Additionally, the BRS was found to better inhibit the expression of inflammatory factors in their peripheral blood and could correct acidosis.

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Section: Discussionsupporting

confidence: 83%

Hemorrhagic, hypovolemic shock resuscitated with Ringer’s solution using bicarbonate versus lactate: A CONSORT-randomized controlled study comparing patient outcomes and blood inflammatory factors

et al. 2022

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“…[18] Similar findings were observed in another rat model of hemorrhagic shock resuscitation, with Plasma-Lyte producing more rapid correction of acid base abnormalities and less intestinal injury when compared with either Ringer’s Lactate or normal saline. [19]…”

Section: Introductionmentioning

confidence: 99%

0.9% NaCl (Normal Saline) – Perhaps not so normal after all?

Blumberg

Cholette

Pietropaoli

et al. 2018

Transfusion and Apheresis Science

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Crystalloid infusion is widely employed in patient care for volume replacement and resuscitation. In the United States the crystalloid of choice is often normal saline. Surgeons and anesthesiologists have long preferred buffered solutions such as Ringer's Lactate and Plasma-Lyte A. Normal saline is the solution most widely employed in medical and pediatric care, as well as in hematology and transfusion medicine. However, there is growing concern that normal saline is more toxic than balanced, buffered crystalloids such as Plasma-Lyte and Lactated Ringer's. Normal saline is the only solution recommended for red cell washing, administration and salvage in the USA, but Plasma-Lyte A is also FDA approved for these purposes. Lactated Ringer's has been traditionally avoided in these applications due to concerns over clotting, but existing research suggests this is not likely a problem. In animal models and clinical studies in various settings, normal saline can cause metabolic acidosis, vascular and renal function changes, as well as abdominal pain in comparison with balanced crystalloids. The one extant randomized trial suggests that in very small volumes (2 l or less) normal saline is not more toxic than other crystalloids. Recent evidence suggests that normal saline causes substantially more in vitro hemolysis than Plasma-Lyte A and similar solutions during short term storage (24 hours) after washing or intraoperative salvage. There are now abundant data to raise concerns as to whether normal saline is the safest replacement solution in infusion therapy, red cell washing and salvage, apheresis and similar uses. In the USA, Plasma-Lyte A is also FDA approved for use with blood components and is likely a safer solution for these purposes. Its only disadvantage is a higher cost. Additional studies of the safety of normal saline for virtually all current clinical uses are needed. It seems likely that normal saline will eventually be abandoned in favor of safer, more physiologic crystalloid solutions in the coming years.

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