The use of balanced solutions for fluid therapy. The reserve alkalinity. The ideal infusion solution
ARTICLE PDF (Українська)

Keywords

balanced solutions, colloidal solutions, crystalloid solutions, reserve alkalinity, hyperchloremic acidosis

How to Cite

Cherniy, V. I. (2018). The use of balanced solutions for fluid therapy. The reserve alkalinity. The ideal infusion solution. Clinical and Preventive Medicine, (2-3), 83-92. https://doi.org/10.31612/2616-4868.2-5.2018.10

Abstract

The article describes different types of metabolic acidosis, which has various causes, mechanisms of formation and, consequently, treatment tactics: ketoacidosis and lactic acidosis. In turn, ketoacidosis is divided into diabetic and non-diabetic. Diabetic ketoacidosis is a complex of metabolic disorders, characterized by hyperglycemia, acidosis and ketoneemia, is the result of absolute or relative insulin deficiency. Nondiabetic ketoacidosis is associated with cyclical vomiting syndrome in children and adults (Cyclic Vomiting Syndrome). Lactate acidosis is a universal pathophysiological condition that develops in conditions of hypoxia (both acute and chronic). There are other causes of metabolic acidosis: hyperchloremic, drug-induced, poisoning (salicylates), etc. Infusion liquids that do not contain a physiological buffer base (bicarbonate) create dilutional acidosis. Uncontrolled infusion therapy with colloidal and crystalloidal plasma substitutes can also lead to the development of hyperchloroemic metabolic acidosis. Dilution acidosis can be prevented by using adequate concentrations of precursor bicarbonate-metabolizable anions to replace HCO-3. The following anions of organic acids are used as metabolizable bases (carriers of reserve alkalinity): acetate (acetic acid), lactate (lactic acid), malate (malic acid). The use of only crystalloid solutions is associated with an increased risk of increasing the volume of the intercellular fluid, which can lead to organ failure during anesthesia and intensive care. Long-term use of large volumes of colloidal solutions is associated with an increased risk of developing various side effects, if indicated, they should be used only at recommended dosages. The most effective and safe in diseases accompanied by the development of metabolic acidosis are complex infusion solutions containing sodium lactate (Reosorbilact, Sorbilact) and sodium acetate (Xylate, Gluсcil), sodium acetate and malate (Ringer Malat). Until now, the "ideal" composition of the "balanced" plasma substitute has not been created.

https://doi.org/10.31612/2616-4868.2-5.2018.10
ARTICLE PDF (Українська)

References

1. Cherniy V. I., Shlapak I., Georgiyants M., Tjumentseva S., Kugler S., Prokopenko B. (2016). Etiology, pathogenesis and intensive care of metabolic acidosis. J. Emergency medicine, 6 (77), 43-56.
2. Hyperchloremic acidosis general information. Available at: http://humbio.ru/humbio/har/000abc4d-ref.htm
3. Yunos N. M., Bellomo R., Hegarty C., et al. (2012). Association between a chloride-liberal vs chloride-restrictive intravenous fluid administration strategy and kidney injury in critically ill adults. JAMA, l, 1566–1572.
4. Yunos N. M., Bellomo R., Story D., Kellum J. (2010). Bench-to-bedside review: chloride in critical illness. J. KCrit Care, 14, 226.
5. Tavernier B., Faivre S., Bourdon C. Hyperchloremic acidosis resulting from plasma replacement. Federation of Anesthesiology and Intensive Care Medicine, Lille University Teaching Hospital, Lille, France. Available at: www.critical.ru/actual/infuz/hyperchlor.htm
6. Cherniy V., Kolesnikov A., Oleynikov K., Egorov A., Beloshapka V. (2012). Ratsional'naya infuzionnaya terapiya [Rational infusion therapy]. Donetsk: Izdatel' Zaslavs'kiy A. YU, 182.
7. Morgan T. J., Venkatesh B., Beindorf A., et al. (2007). Acid-base and bio-energetics during balanced versus unbalanced normovolaemic haemodilution. AnaesthIntensive Care, 35, 173–179.
8. Kurtz I., Kraut J., Ornekian V., Nguyen M. K. (2008). Acid-base analysis: a critique of the Stewart and bicarbonate-centered approaches. Am J Physiol Renal Physiol., 294, 1009–31.
9. Doberer D., Funk G. C., Kirchner K., Schneeweiss D. A. (2009). A critique of Stewart’s approach: the chemical mechanism of dilutional acidosis. Intensive Care Med, 35, 2173–80.
10. Benoît Tavernier, Sébastien Faivre, Caroline Bourdon. Hyperchloremic acidosis resulting from plasma replacement. Federation of Anesthesiology and Intensive Care Medicine, Lille University Teaching Hospital. Lille, France. Available at: www.critical.ru/actual/infuz/hyperchlor.htm
11. Tavernier B., Faivre S., Bourdon C. (2010). Hyperchloremic acidosis during plasma expansion. Transfus Altern Transfus Med., 11 (Suppl. 3), 3–9.
12. Muller L., Lefrant J. Y. Metabolic effects of plasma expanders (2010). Transfus Altern Transfus Med., 11 (Suppl. 3), 10–21.
13. Conte B., L'Hermite J., Ripart J., Lefrant J. Y. (2010). Perioperative optimization of oxygen delivery. Transfus Altern Transfus Med.,11 (Suppl. 3), 22–29.
14. Guidet B., Soni N., Della Rocca G., Kozek S., Vallet B., Annane D., James M. (2010). A balanced view of balanced solutions. Crit Care, 5, 325.
15. British consensus guidelines on intravenous fluid therapy for adult surgical patients (GIFTASUP) – Cassandra’s view. Anaesthesia, 64, 235–238. doi: 10.1111/j.1365-2044.2009.05886_1.x.
16. Gorovenko N., Gumenuk N., Derkach N. (2002). The use of infusion preparations for the correction of metabolic acidosis. Ukr. Chemotherapy J., 1-2, 29-33.
17. Cherniy V., Shlapak I., Georgiyants M., Tjumentseva S., Kugler S., Prokopenko B. (2016). Etiology, pathogenesis and intensive care of metabolic acidosis. J. Emergency medicine, 7, 51-68.
18. Myburgh J. A. (2015). Fluid resuscitation in acute medicine: what is the current situation? J Intern Med., 277, 58–68.
19. Rochwerg B. (2014). Fluid Resuscitation in Sepsis. A Systematic Review and Network Meta-analysis. Ann Intern Med., 161, 347-355.
20. Marik P., Bellomo R. (2016). A rational approach to fluid therapy in sepsis. British Journal of Anaesthesia, 3, 339–49.
21. WHO Model List of Essential Medicines. 19th List. April 2015 as amended November 2015. Available at: http://pda.apteka.ua/article/333051.
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