Is Hartmann's the solution?

Abstract

SummaryAs Hartmann's solution is commonly used by anaesthetists, we surveyed a group of Part III FRCA candidates to establish their knowledge of its constituents and the purpose and metabolism of the lactate in solution. Of the 82 candidates surveyed only three (4%) accurately recorded the electrolytes and their concentrations in Hartmann's solution. Lactate was stated to be a source of bicarbonate by 52 (63%) and a source of glucose by 17 (21%). The descriptions of lactate metabolism were largely imprecise, none was complete and 24 (29%) of candidates offered no explanation. The constituents of Hartmann's solution and their concentrations are designed to match those of plasma, reducing ion and fluid shifts postinfusion. The lactate in Hartmann's solution is metabolised by both oxidation and gluconeogenesis, predominantly in the liver, and bicarbonate is generated by both processes over 1-2 h. Hartmann's solution is often regarded as the anaestheticpanacea of fluid resuscitation. This crystalloid formulation is routinely employed as the rehydration and maintenance solution of choice in the operating theatre. In discussion with colleagues it became apparent that knowledge regarding the concentration of the constituent ions and the metabolism of the lactate content varied widely. We therefore decided to assess the level of knowledge about Hartmann's solution amongst the wider anaesthetic community. MethodsWe obtained permission from The Royal College of Anaesthetists to survey candidates attending the Part III FRCA College course in February 1996. At the end of an afternoon lecture session, those present were asked to complete a voluntary and confidential questionnaire. The candidates were given no time limit for completing the task, but were instructed not to confer with each other, nor to refer to texts. The questionnaire (see Appendix 1) asked for the following information: 1 the constituents and their concentrations in 1 litre of 0.9% sodium chloride; 2 the constituents and their concentrations in 1 litre of Hartmann's solution; 3 the purpose of the lactate in Hartmann's solution; 4 the metabolism of the lactate in Hartmann's solution.In addition to the survey, we also reviewed the anaesthetic textbooks present in the anaesthetic library of The Royal London Hospital to establish the availability of 'source information' under the following headings: 1 Hartmann's solution -constituents, metabolism; 2 Ringer's lactate solution -constituents, metabolism; 3 lactate metabolism.

Histidine Inhibits the Degradation of Cells Suspended in Ringer’s Lactate

“…He had an interest in pediatrics and developed the solution with the intention of treating acidosis in children (Wikipedia http://en.wikipedia.org/wiki/Ringer's lactate). 6 RL has served the original intention for its creation well. However, we currently administer large amounts of RL for patients with hemorrhagic shock.…”

Allergy to Lactated Ringer Solution—An Unusual Case Presentation

“…Hartmann modified the solution by adding lactate, which mitigates changes in pH by acting as a buffer for acid. Thus, the solution became known as the ÔLactated Ringer SolutionÕ and later, as the ÔHartmann solution.Õ 5 The lactated Ringer solution is isotonic with blood and intended for intravenous administration. It is a sterile, nonpyrogenic solution for fluid and electrolyte replenishment and caloric supply in a single dose container for intravenous administration.…”

Evolution of fluid therapy

“…There were no further developments in crystalloids for the next 50 years, until Ringer's solution was modified by the American paediatrician Alexis Hartmann in the 1930s. By adding lactate to the Ringers solution in order to provide a buffer for acid, he invented the "Ringer's lactated" or "Hartmann's solution" [14] (table 1) for rehydration of children with gastroenteritis, which is used worldwide until the present day.…”