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Randomized Controlled Trial
. 2017 Apr 5;12(4):e0174507.
doi: 10.1371/journal.pone.0174507. eCollection 2017.

Different effects of fluid loading with saline, gelatine, hydroxyethyl starch or albumin solutions on acid-base status in the critically ill

Angélique M E Spoelstra-de Man  1 , Annemieke Smorenberg  2 , A B Johan Groeneveld  3
Affiliations
Randomized Controlled Trial

Different effects of fluid loading with saline, gelatine, hydroxyethyl starch or albumin solutions on acid-base status in the critically ill

Angélique M E Spoelstra-de Man et al. PLoS One. .

Abstract

Introduction: Fluid administration in critically ill patients may affect acid-base balance. However, the effect of the fluid type used for resuscitation on acid-base balance remains controversial.

Methods: We studied the effect of fluid resuscitation of normal saline and the colloids gelatine 4%, hydroxyethyl starch (HES) 6%, and albumin 5% on acid-base balance in 115 clinically hypovolemic critically ill patients during a 90 minute filling pressure-guided fluid challenge by a post-hoc analysis of a prospective randomized clinical trial.

Results: About 1700 mL was infused per patient in the saline and 1500 mL in each of the colloid groups (P<0.001). Overall, fluid loading slightly decreased pH (P<0.001) and there was no intergroup difference. This mildly metabolic acidifying effect was caused by a small increase in chloride concentration and decrease in strong ion difference in the saline- and HES-, and an increase in (uncorrected) anion gap in gelatine- and albumin-loaded patients, independent of lactate concentrations.

Conclusion: In clinically hypovolemic, critically ill patients, fluid resuscitation by only 1500-1700 mL of normal saline, gelatine, HES or albumin, resulted in a small decrease in pH, irrespective of the type of fluid used. Therefore, a progressive metabolic acidosis, even with increased anion gap, should not be erroneously attributed to insufficient fluid resuscitation.

Trial registration: ISRCTN Registry ISRCTN19023197.

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Conflict of interest statement

Competing Interests: I have read the journal's policy and the authors of this manuscript have the following competing interests. This study has been supported by an unrestricted grant of B. Braun Medical Melsungen, Germany. The funder was not involved in the study design, data collection, analysis, writing, or submission of the manuscript.

Figures

Fig 1
Fig 1. Commonly used formulas to assess acid base status according to Stewart and Henderson-Hasselbalch.
Fig 2
Fig 2. Patient population flow chart.
N; number. HES; hydroxyethyl startch.
Fig 3
Fig 3. Sodium-chloride differences and (un)corrected anion gaps in various fluid types.
(A) Mean (error bars represent +/- standard deviation) of sodium-chloride differences (Na+-Cl-) at baseline and after 90 minutes loading of various fluid types. For sodium-chloride difference: P = 0.032 T = 90 vs T = 0, P<0.001 for change between groups and P<0.001 for change in gelatine or albumin vs saline and hydroxyethyl starch (HES). (B) Mean of uncorrected anion gaps at baseline and after 90 minutes loading of various fluid types. P<0.001 for change between groups, P = 0.027 or lower for change in gelatine vs saline and hydroxyethyl starch (HES) and change in albumin vs saline and HES. P<0.001 for change in HES vs gelatine and albumin. (C) Mean of corrected anion gaps (AG) at baseline and after 90 minutes loading of various fluid types. P<0.001 for change between groups, P<0.001 for change in gelatine vs saline, hydroxyethyl starch (HES), and albumin.
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