Soto TAF, Torres HC, Fortuna CJA, Fierro FLL, Rivera MJR, Méndez MMA

Language: Spanish
References: 17
Page: 167-172
PDF size: 204. Kb.

ABSTRACT

Objective: To determine the presence of hyperchloremic acidosis associated with the use of crystalloid solutions in patients with trauma who entered the Intensive Care Unit of Hospital General Xoco.
Background: To restore the circulation in patients with trauma is intended to ensure adequate tissue perfusion and avoid excessive accumulation of fluid in the interstitium. Today, the correction of hypovolemia is based on the use of crystalloids and/or colloids. Saline solution is preferred because it is isotonic and cheap, but to infuse large volumes of this, there are changes to the acid-base balance. This is a retrospective study to determine the presence of hyperchloremic acidosis associated with the use of crystalloid solutions in patients with trauma admitted to the Intensive Care Unit (ICU) of Hospital General Xoco.
Material and methods: We reviewed the files of patients admitted for trauma during the period December 26, 2008 to June 25, 2009. Was recorded, age, sex, type of illness, trauma or medical; probability of death through the scale of ISS and APACHE II, cause of discharge, and hours in the Emergency Room or operating room prior to admission to ICU, days in ICU stay, cost of care in ICU for days, estimated by SiGenera project. Were the characteristics and quantity of solution administered prior to admission to the ICU. In all cases, reporting record arterial blood gases, serum electrolytes, lactate reported during the first 6 hours of stay in ICU. Calculate the AG = Na - Cl - HCO₃ is why I believe the error or predictive value for metabolic acidosis: pH↓ Cl = (Na - (Cl - HCO₃) / Lactate / EB.
Results: Administration of crystalloids resulted in significantly decreased pH 7.30 ± 0.11, and HCO₃-16.48 ± 4.82, lactate 3.47 ± 0.87, and Cl-increased to 109.21 ± 4.45. The AG was found in 11.4 ± 3.57 and the ratio of error to predict the degree acidosis in hyperchloremia by 0.4057 ± 0.19 (p › 0.01). The length of stay in ICU was 6.42 ± 4.85 days, days with a cost/patient of 51, 625.76.
Conclusions: The infusion of large volumes of crystalloids acidosis hyperchloremic occurs with normal AG, there is a direct impact of this phenomenon in the days of hospital stay and costs day/patient.

REFERENCES

1. Water JH, Bernstein CA. Dilutional acidosis following Hetastarch or Albumin in Healthy Volunteers. Anesthesiology 2000;93:1184-7.

2. Scheingraber S et al. Rapid saline infusion produces hyperchloremic acidosis in patients undergoing gynecologic surgery. Clinic of Anesthesiology 2008.

3. Skellett S, et al. Chasing the base deficit: hyperchloraemic acidosis following 0.9% saline fluid resuscitation. Arch Dis Child 2000;83:514-516.

4. Roche AM et al. A head-to-head comparison of the in vitro coagulation effects of saline-based and balanced electrolyte crystalloid and colloid intravenous fluids. Anesth Analg 2006;102:1274-9.

5. Schortgen F et al. Preferred plasma volume expanders for critically ill patients: results of an international survey. Intensive Care Med 2004;30:2222-2229.

6. Editorial II. The balanced concept of fluid resuscitation. British Journal of Anaesthesia 2007;99 (3):312-15.

7. Morgan TJ. Clinical review: The meaning of acid–base abnormalities in the intensive care unit – effects of fluid administration. Critical Care 2005;9:204-211.

8. Boldt J. Balanced volume replacement strategy: Fact or fiction? Intensive Care Medicine Annual Update 2007.

9. Alam HB, Rhee P. New developments in fluid resuscitation. Surg Clin N Am 2007;87:55-72.

10. Williams EL et al. The effect of intravenous lactated ringer’s solution versus 0.9% sodium chloride solution on serum osmolality in human volunteers. Anesth Analg 1999;88:999-1003.

11. SAFE Study Investigators; effect of baseline serum albumin concentration on outcome of resuscitation with albumin or saline in patients in intensive care units: analysis of data from the saline versus albumin fluid evaluation (SAFE) study. BMJ 2006;333:1044.

12. Stephens R. Resuscitation fluids and hyperchloraemic metabolic acidosis. Trauma 2003;5(2):141-147.

13. Zeynep E et al. The combination of normal saline and lactated ringer´s solution for large intravascular volume infusion. Marmara Medical Journal 2004;17(1):22-27.

14. Rehm M, Finsterer U. Treating intraoperative hyperchloremic acidosis with sodium bicarbonate or tris-hydroxymethyl aminomethane: A randomized prospective study. Anesth Analg 2003;96:1201-8.

15. Carrillo-Esper R, Visoso-Palacios P. Acidosis metabólica hiperclorémica en el perioperatorio. Rev Mex Anes 2006;29(4).

16. Carrillo-Esper R, Rocha-Machado J. Reanimación dirigida por metas. Rev Mex Anest 2005;28(1):S164-S168.

17. Penney, Oleesky D. Renal tubular acidosis. Ann Clin Biochem 1999;36:408-422.