Influence of an acetate- and a lactate-based balanced infusion solution on acid base physiology and hemodynamics: an observational pilot study

Abstract

BackgroundThe current pilot study compares the impact of an intravenous infusion of Ringer’s lactate to an acetate-based solution with regard to acid–base balance. The study design included the variables of the Stewart approach and focused on the effective strong ion difference. Because adverse hemodynamic effects have been reported when using acetate buffered solutions in hemodialysis, hemodynamics were also evaluated.MethodsTwenty-four women who had undergone abdominal gynecologic surgery and who had received either Ringer’s lactate (Strong Ion Difference 28 mmol/L; n = 12) or an acetate-based solution (Strong Ion Difference 36.8 mmol/L; n = 12) according to an established clinical protocol and its precursor were included in the investigation. After induction of general anesthesia, a set of acid–base variables, hemodynamic values and serum electrolytes was measured three times during the next 120 minutes.ResultsPatients received a mean dose of 4,054 ± 450 ml of either one or the other of the solutions. In terms of mean arterial blood pressure and norepinephrine requirements there were no differences to observe between the study groups. pH and serum HCO3- concentration decreased slightly but significantly only with Ringer’s lactate. In addition, the acetate-based solution kept the plasma effective strong ion difference more stable than Ringer’s lactate.ConclusionsBoth of the solutions provided hemodynamic stability. Concerning consistency of acid base parameters none of the solutions seemed to be inferior, either. Whether the slight advantages observed for the acetate-buffered solution in terms of stability of pH and plasma HCO3- are clinically relevant, needs to be investigated in a larger randomized controlled trial.

A Comparison of Sterofundin and Ringer’s Lactate on Intraoperative Acid Base and Electrolytes Status in Children: A Randomized Controlled Trial

“…The hemodynamics profile remained stable throughout and was comparable in both groups. Although acetatecontaining solutions have been reported to cause severe hemodynamic instability due to increased nitric oxide synthesis and enhanced arrhythmias, this was only noted in patients who were undergoing haemodialysis [14]. In our study, we did not infuse any glucose solution intravenously.…”

Balanced Fluid Versus Saline-Based Fluid in Post-operative Severe Traumatic Brain Injury Patients: Acid-Base and Electrolytes Assessment

“…The balanced solution gives a more stable plasma bicarbonate level. A pilot study by Hofmann-Kiefer showed that slight advantages were observed in the acetate-buffered solution in terms of pH and plasma HCO3-stability in comparison with the lactate-based balanced solution (25). The balanced solution with acetate buffer is also more advantageous than a lactate-based buffer in terms of metabolism and clearance because it does not depend on the liver function (14).…”

What is the ideal crystalloid?

“…In a small study comparing the use of balanced solutions containing either lactate (Lactated Ringer's) or acetate for patients undergoing abdominal gynecologic surgery, both solutions showed similar effects on hemodynamic stability and vasopressor use. However, acetate-based solution led to a greater stability of the plasma SID, with a decrease in pH and serum bicarbonate concentrations in the group that received Lactated Ringer's [16].…”