Effect of hyperchloremia on mortality of pediatric trauma patients: a retrospective cohort study

ABSTRACT BACKGROUND: Hyperchloremia is often encountered due to the frequent administration of intravenous fluids in critically ill patients with conditions such as shock or hypotension in the pediatric intensive care unit, and high serum levels of chloride are associated with poor clinical outcomes. OBJECTIVES: This study aimed to determine the association between hyperchloremia and in-hospital mortality in pediatric patients with major trauma. DESIGN AND SETTING: This retrospective cohort study was conducted at a tertiary university hospital in Turkey. METHODS: Data were collected between March 2020 and April 2022. Patients aged 1 month to 18 years with major trauma who received intravenous fluids with a concentration > 0.9% sodium chloride were enrolled. Hyperchloremia was defined as a serum chloride level > 110 mmol/L. Clinical and laboratory data were compared between the survivors and nonsurvivors. RESULTS: The mortality rate was 23% (n = 20). The incidence of hyperchloremia was significantly higher in nonsurvivors than in survivors (P = 0.05). In multivariate logistic analysis, hyperchloremia at 48 h was found to be an independent risk factor for mortality in pediatric patients with major trauma. CONCLUSIONS: In pediatric patients with major trauma, hyperchloremia at 48-h postadmission was associated with 28-day mortality. This parameter might be a beneficial prognostic indicator.

A Case of Graves' Disease That Was Misdiagnosed as Thyrotoxic Crisis because of Chronic Bromvalerylurea Intoxication / 日本プライマリ・ケア連合学会誌

A woman in her 50s presented to the hospital with a chief complaint of headache and nausea. Graves' disease was diagnosed based on positive blood test results for thyrotoxicosis and TSH receptor antibody and ultrasonographic thyroid gland findings. The patient was hospitalized and started treatment with thiamazole; however, after hospitalization, psychiatric symptoms, such as visual and auditory hallucinations, appeared, and she fulfilled the diagnostic criteria for thyroid crisis. We increased the dose of thiamazole and added potassium iodide. Thyroid function improved; however, the patient experienced reemergence of psychiatric symptoms. Blood tests revealed pseudohyperchloremia, which led to the discovery of abuse of over-the-counter analgesics containing bromwarelyl urea. The psychiatric symptoms were suspected to be due to withdrawal from chronic bromine intoxication. After starting psychotropic drugs, the patient's psychiatric symptoms became mild, her thyroid function continued to improve steadily, and she was discharged from the hospital. Thyroid crisis is a condition that should be suspected and treated at an early stage; however, the diagnostic criteria for thyroid crisis can be false-positive if the thyroid disease is accompanied by other conditions that cause psychiatric symptoms.

Analysis of risk factors of major adverse kidney events within 30 days in patients with acute pancreatitis / 中华危重病急救医学

Objective:To analyze the risk factors of major adverse kidney events within 30 days (MAKE30) in patients with acute pancreatitis (AP).Methods:A retrospective cohort study was conducted. A total of 162 patients who were first diagnosed with AP in the First Affiliated Hospital of Soochow University from June 2019 to June 2021 and the onset time was less than 72 hours were enrolled. Patients were divided into MAKE30 group and non-MAKE30 group according to the occurrence of MAKE30 after hospitalization. MAKE30 was defined as death from any cause, new renal replacement therapy (RRT), and persistent renal insufficiency (PRD). The clinical data of the two groups at admission were compared. The independent risk factors of MAKE30 were analyzed by multivariate Logistic regression method, and a regression equation was established as a quantitative prediction model of MAKE30. Receiver operator characteristic curve (ROC curve) was drawn to analyze the prediction of the quantitative prediction model value.Results:All 162 patients were included in the final analysis, including 32 in the MAKE30 group and 130 in the non-MAKE30 group. Univariate analysis showed that compared with the non-MAKE30 group, the body mass index (BMI), the proportion of severe AP, and the acute physiology and chronic health evaluation Ⅱ (APACHEⅡ) score, the sequential organ failure assessment (SOFA) score, blood urea nitrogen (BUN), serum creatinine (SCr), C-reactive protein (CRP), HCO 3-, Cl - levels and the proportion of hyperchloremia at admission in the MAKE30 group were significantly increased. Multivariate Logistic regression analysis showed that APACHE Ⅱ score at admission [odds ratio ( OR) = 1.659, 95% confidence interval (95% CI) was 1.426-1.956, P = 0.009], SOFA score ( OR = 1.501, 95% CI was 1.236-1.840, P = 0.014) and hyperchloremia ( OR = 1.858, 95% CI was 1.564-2.231, P = 0.004) were independent risk factors for MAKE30 in AP patients. The MAKE30 regression equation was established by the above risk factors [Logit( P) = 0.063+0.525×APACHEⅡ score+0.328×SOFA score+0.895×hyperchloremia], which was used as the MAKE30 quantitative prediction model. ROC curve analysis showed that the area under the ROC curve (AUC) of the model for predicting MAKE30 was 0.846 (95% CI was 0.774-0.923, P = 0.001). The patients were divided into two subgroups with hyperchloremia (Cl -≥110 mmol/L, n = 19) and non-hyperchloremia (Cl - < 110 mmol/L, n = 143) according to the blood Cl - level at admission. The incidence of MAKE30 and acute kidney injury (AKI) in the hyperchloremia group was significantly increased (MAKE30: 68.4% vs. 13.3%, AKI: 89.5% vs. 43.4%), and the levels of BUN and SCr at admission were significantly increased [BUN (mmol/L): 9.3±2.5 vs. 5.9±1.1, SCr (μmol/L): 162.3±26.4 vs. 78.6±9.2], the total length of hospital stay and length of intensive care unit (ICU) stay were significantly longer [total length of hospital stay (days): 10.2±1.6 vs. 5.6±1.2, length of ICU stay (days): 6.2±1.0 vs. 3.1±0.6], the cumulative intravenous infusion volume increased significantly at 48 hours and 72 hours (mL: 7 235.9±1 025.3 vs. 5 659.6±956.7 at 48 hours, 11 052.6±1 659.8 vs. 7 156.9±1 052.4 at 72 hours), differences were statistically significant (all P < 0.01). Conclusions:MAKE30 can be used as an important indicator to evaluate the short-term clinical prognosis of AP patients. APACHEⅡ score, SOFA score and hyperchloremia at admission are the main risk factors. The risk model of MAKE30 based on these three indicators has good predictive performance. AP patients with hyperchloremia are at high risk of developing MAKE30, which should be highly regarded in clinical practice.

Saline for adverse effects caused by septic shock fluid resuscitation and the exploration of new resuscita￣tion fluid / 中国小儿急救医学

Sepsis is a life￣threatening organ dysfunction caused by deleterious host response due to infection. Septic shock is a type of sepsis that has a high mortality rate worldwide each year. At present, 0. 9% saline is still the first choice for resuscitation fluid in septic shock in the world,but hyperchloremia and acute kidney injury caused by 0. 9% saline resuscitation are receiving more and more attention. This review elaborates on the mechanism of hyperchloremia and acute kidney injury caused by saline,and explores a new type of liquid (balanced crystalloids) instead of 0. 9% saline for fluid resuscitation,thereby reducing compli￣cations caused by fluid resuscitation.

Impacto del componente hiperclorémico de la acidosis metabólica en el estado de hidratación y en el tratamiento de la cetoacidosis diabética / Impact of the hyperchloremic component of metabolic acidosis on the patient's hydration status and the treatment of diabetic ketoacidosis

Introducción. La cetoacidosis diabética (CAD) se caracteriza por acidosis metabólica (AM) con anión restante (AR) elevado, aunque, ocasionalmente, puede presentar hipercloremia. Se postuló que la presencia de hipercloremia inicial podría reflejar un mejor estado de hidratación; sin embargo, su prevalencia y su impacto en el tratamiento de la CAD se desconoce. Objetivos. Determinar la prevalencia de AM con componente hiperclorémico previo al inicio del tratamiento y evaluar si su presencia se asocia con mejor estado de hidratación y con menor tiempo de salida de la CAD, en comparación con los pacientes con AR elevado exclusivo. Pacientes y métodos. Se agruparon los pacientes internados con CAD (período entre enero de 2014 y junio de 2016) según presentaran, al ingresar, AM con AR elevado exclusivo o con hipercloremia y se compararon sus variables clínicas, de laboratorio y la respuesta al tratamiento. Resultados. Se incluyeron 40 pacientes -amp;#91;17 varones, mediana de edad: 14,5 años (2,4-18)-amp;#93;, 22 con AM con componente hiperclorémico (prevalencia de 55%) y 18 con AR elevado exclusivo. La presencia de hipercloremia no se asoció con mejor estado de hidratación (porcentaje de déficit de peso en ambos grupos: 4,9%; p= 0,81) ni con una respuesta terapéutica más rápida (con componente hiperclorémico: 9,5 horas; con AR elevado exclusivo: 11 horas; p= 0,64). Conclusiones. En niños con CAD, la prevalencia de AM con componente hiperclorémico fue del 55% y no se asoció con un mejor estado de hidratación ni con una salida más temprana de la descompensación metabólica.

Introduction. Diabetic ketoacidosis (DKA) is characterized by metabolic acidosis (MA) with a high anion gap (AG), although, occasionally, it can present with hyperchloremia. It has been postulated that the early presence of hyperchloremia could reflect a better hydration status; however, its prevalence and impact on DKA treatment remain unknown. Objectives. To determine the prevalence of the hyperchloremic component in MA prior to treatment and to assess whether it is associated with a better hydration status and a shorter recovery time from DKA compared to patients with high AG only. Patients and Methods. Patients hospitalized with DKA (between January 2014 and June 2016) were grouped according to whether they were admitted with MA with high AG only. or with hyperchloremia, and clinical and laboratory outcome measures and response to treatment were compared. Results. Forty patients (17 males, median age: 14.5 years -amp;#91;2.4-18-amp;#93;) were included; 22 with hyperchloremic metabolic acidosis (prevalence of 55%) and 18 with metabolic acidosis with high AG only. The presence of hyperchloremia was not associated with a better hydration status (weight loss percentage in both groups: 4.9%; p= 0.81) nor with a faster treatment response (MA with a hyperchloremic component: 9.5 hours; MA with high AG only: 11 hours; p= 0.64). Conclusions. The prevalence of MA with a hyperchloremic component among children with DKA was 55% and was not associated with a better hydration status nor with a faster recovery from the metabolic decompensation.

Predictors and Outcome of Acute Kidney Injury in Children with Diabetic Ketoacidosis

Objective: To identify predictors and outcome of acute kidney injury (AKI) in children withdiabetic ketoacidosis (DKA) admitted to a Pediatric Intensive Care Unit (PICU). Methods:Retrospective case review of 79 children with DKA admitted between 2011-2014. Results: 28children developed AKI during the hospital stay; 20 (71.4%) recovered with hydration alone.Serum chloride at 24 hours was independently associated with AKI. Children with AKI hadprolonged acidosis, longer PICU stay, and higher mortality. Conclusions: Majority of childrenwith AKI and DKA recover with hydration. Hyperchloremia at 24 hours had independentassociation with AKI, although cause-effect relation could not be ascertained.

Soluciones balanceadas: cloro el «nuevo villano¼ / Balanced solutions: chlorine the «new villain¼ / Soluções equilibradas: cloro «o novo vilão¼

Resumen: Las consecuencias de la reanimación con líquidos por lo regular se han minimizado y aceptado como un «mal necesario¼. En la mayoría de los casos su origen es iatrogénico. En años recientes se ha prestado mucha atención a las soluciones balanceadas, las cuales poseen una cantidad de electrolitos más parecida al plasma humano que otro tipo de soluciones. El objetivo de esta revisión es conocer aspectos fisiopatológicos y la evidencia actual respecto al uso de soluciones balanceadas en los pacientes críticamente enfermos, resaltar los efectos deletéreos de la hipercloremia y su asociación a malos resultados. Para comprender cómo funcionan las soluciones balanceadas debe conocerse el modelo de Stewart para las alteraciones ácido-base. El interés por la hipercloremia se debe a que la administración de soluciones es la maniobra más común en medicina crítica y a su vez la solución salina al 0.9% es el líquido que principalmente se administra. La solución salina al 0.9% puede convertirse en un «problema¼ y no en una «solución¼ si no se selecciona al paciente correcto. Las soluciones balanceadas son una opción, pero no la misma solución para los diferentes casos de pacientes críticamente enfermos.

Abstract: The consequences of resuscitation with liquids are usually minimized and accepted as a «necessary evil¼, in most cases their origin is iatrogenic. Recently much attention has been paid to balanced solutions which have a quantity of electrolytes more similar to human plasma than other types of solutions. The objective of this review is to know the pathophysiological aspects and current evidence regarding the use of balanced solutions in critically ill patients. Highlight the deleterious effects of hyperchloremia and its association with poor results. To understand how balanced solutions work we must know the Stewart Model for acid-base alterations. The interest in hyperchloremia is due to the fact that the administration of solutions is the most common maneuver in acute medicine and in turn the saline solution 0.9% the liquid mostly administered. The saline solution 0.9% can become a «problem¼ and not a «solution¼ if we do not select the right patient. Balanced solutions are an option, but not a solution in different populations of critically ill patients.

Resumo: As consequências da reanimação com líquidos são normalmente minimizadas e aceitas como um «mal necessário¼, na maioria dos casos é de origem iatrogênica. Recentemente se presta muita atenção nas soluções equilibradas que possuem uma quantidade de eletrólitos mais similares ao plasma humano do que outras soluções. O objetivo desta revisão é conhecer aspectos fisiopatológicos e a evidência atual sobre o uso de soluções equilibradas em pacientes em estado crítico. Destacar os efeitos deletérios da hipercloremia e sua associação com resultados desfavoráveis. Para compreeder como funcionam as soluções equilibradas devemos conhecer o modelo de Stewart para as alterações ácido-base. O interesse pela hipercloremia é pelo fato de que a administração de soluções é o procedimento mais comum na medicina aguda e a solução salina a 0.9% é o liquido mais administrado. A solução salina 0.9% pode se tornar um «problema¼ e não uma «solução¼ se não selecionamos o paciente correto. As soluções equilibradas são uma opção, mas não uma mesma solução para os diferentes casos de pacientes em estado crítico.

Diferencia sodio-cloro e índice cloro/sodio como predictores de mortalidad en choque séptico / Sodium-chloride difference and chloride/sodium ratio as predictors of mortality in septic shock

Resumen ANTECEDENTES: la hipercloremia es la causa más frecuente de acidosis metabólica en pacientes en estado crítico. La diferencia sodio-cloro (Na+-Cl-) y el índice cloro/sodio (Cl-/Na+) pueden valorar de manera simple el papel de la hipercloremia en las alteraciones ácido-base. OBJETIVO: determinar si la diferencia sodio-cloro y el índice cloro/ sodio medidos a las 24 horas de ingreso son predictores de mortalidad a 30 días en pacientes con choque séptico. MATERIAL Y MÉTODO: estudio de cohorte prospectivo, longitudinal, descriptivo y analítico. Se incluyeron los pacientes con diagnóstico de choque séptico según las Guías de la Campaña Sobreviviendo a la Sepsis del año 2012, ingresados a la Unidad de Cuidados Intensivos en el periodo comprendido de junio del 2015 a junio de 2016. RESULTADOS: el análisis multivariado mostró que la diferencia Na+-Cl- menor de 31 mEq/L incrementa el riesgo de muerte en los pacientes con choque séptico a 30 días, OR 15.26 (IC95% 1.56-148.49) p=0.019. CONCLUSION: la disminución de la diferencia Na+-Cl- por debajo de 31 mEq/L condicionada por hipercloremia incrementa el riesgo de muerte a 30 días en el paciente con choque séptico.

Abstract BACKGROUND: Hyperchloremia is the most common cause of metabolic acidosis in critically ill patients. The sodium-chloride difference (Na+-Cl-) and chloride/sodium ratio (Cl-/Na+) may simply evaluate the role of hyperchloremia in acid-base disturbances. OBJECTIVE: To determine if sodium-chloride difference and chloride/ sodium ratio measured at 24 h of admission are mortality predictors at 30 days in patients with septic shock. MATERIAL AND METHOD: A prospective cohort, longitudinal, descriptive and analytic study was done including patients diagnosed with septic shock according to the guidelines of the Surviving Sepsis Campaign in 2012, admitted to the Intensive Care Unit in the period comprising from June 2015 to June 2016. RESULTS: The multivariate analysis showed that the Na+-Cl- difference less than 31 mEq/L increases the risk of death in patients with septic shock at 30 days, OR 15.26 (95% CI 1.56-148.49) p=0.019. CONCLUSION: The decrease in the Na+-Cl- difference below 31 mEq/L conditioned by hyperchloremia increases the risk of death at 30 days in the patient with septic shock.

Uso de soluciones intravenosas y su relación con la lesión renal aguda en la Unidad de Terapia Intensiva / Intravenous fluids and its relationship with acute kidney injury in the Intensive Care Unit / Uso de soluções intravenosas e sua relação com a lesão renal aguda na Unidade de Terapia Intensiva

Resumen: Introducción: La lesión renal aguda se define como una elevación de la creatinina superior a 0.3 mg/dL o una disminución en los flujos urinarios en las últimas seis horas en cualquier paciente. Métodos: Sostuvimos la hipótesis de que los pacientes admitidos en la Unidad de Terapia Intensiva (UTI) durante 2013 presentaban mayor incidencia de lesión renal aguda, puesto que eran reanimados con mayor cantidad de solución salina al 0.9% que los pacientes ingresados en la actualidad. Comparamos dos grupos de pacientes en dos periodos distintos (años 2013 y 2015). Se recabaron diariamente datos sobre el balance de líquidos (BL), criterios de lesión renal (LR) y tipo y cantidades de soluciones administradas. Resultados: Durante el periodo entre julio y agosto de 2013 se incluyó un total de 30 pacientes y durante el periodo comprendido entre julio y agosto de 2015 se incluyeron 36, obteniendo un tamaño de muestra de 66 pacientes (n = 66). No se encontró asociación estadísticamente significativa en cuanto al tipo y cantidad de solución cristaloide administrada con respecto a la presencia de lesión renal aguda (p = 0.8) y días de estancia en la UTI (p = 0.45). Se observó asociación estadísticamente significativa entre lesión renal y el uso de coloides como solución intravenosa (p = 0.01). Conclusiones: Actualmente se tiene una tendencia a utilizar más soluciones intravenosas balanceadas, la lesión renal aguda debe prevenirse en la UTI.

Abstract: Introduction: Acute Kidney Injury (AKI) is defined as an elevation of serum creatinine of 0.3 mg/dL and more, or as the presence of low urine output for less tan 0.3 mL/kg/hour for at least six hours. Methods: We had the hypothesis that the patients atmitted to the Intensive Care Unit (ICU) during 2013 used to have high incidence of AKI because they were resucitated with more saline 0.9% solution than patients today. We compare two groups of patients in different periods of time (years 2013 and 2015). We recorded every day different data like fluid balance (FB), cirteria of acute kidney injury (AKI) and type and quantity of intravenous fluids. Results: During the period of July-August 2013 we included 30 patients, and during the lapse of time of July-August 2015 we included 36 patients, for a total number of 66 patients (n = 66). There was no statistic association between the type or the quantity of cristalloid intravenous fluid administered with the incidence of AKI (p = 0.8) and the lenght of ICU stay (p = 0.45). We found only statistic significance between AKI and the use of colloids as an intravenous fluid (p = 0.01). Conclusions: Nowadays we have the trend of use more balance intravenous fluids, the acute kidney injury has to be forewarned and avoided in the ICU.

Resumo: A lesão renal aguda é definida como uma elevação da creatinina de 0.3 mg/dL ou uma diminuição do fluxo urinário nas últimas 6 horas em qualquer paciente. Métodos: Nossa hipótese foi que os pacientes admitidos na Unidade de Terapia Intensiva durante 2013 apresentaram uma maior incidência de lesão renal aguda, devido a que foram reanimados com maior quantidade de solução salina 0.9% que os pacientes admitidos atualmente. Comparou-se dois grupos de pacientes em dois períodos de tempo diferentes (2013 e 2015). Recoletamos diariamente os dados sobre o balance de líquidos (BL), critérios de lesão renal (LR), tipo e quantidades de soluções administradas. Resultados: Durante o período de Julho-Agosto de 2013, foram incluídos um total de 30 pacientes e durante o período compreendido entre Julho-Agosto de 2015 foram incluídos 36 pacientes, dando um tamanho de amostra de 66 pacientes (n = 66). Não encontramos uma associação estatisticamente significativo em quanto ao tipo e quantidade de solução cristalóide administrada, no que diz respeito a apresentação da lesão renal aguda (p = 0.8) e dias de permanência na UTI (p = 0.45). Encontramos uma associação estatisticamente significativa entre a lesão renal e o uso de colóides como solução intravenosa (p = 0.01). Conclusões: Atualmente existe uma tendência para utilizar soluções intravenosas mais equilibradas, devemos prevenir a lesão renal aguda na UTI.

Efeito da suplementação de cloreto de amônio sobre os equilíbrios eletrolítico e ácido-básico e o pH urinário de ovinos confinados / Effect of supplementation of ammonium chloride on electrolyte and acid-base balances and urinary pH of feedlot sheep

A incidência da urolitíase obstrutiva em ovinos é elevada, principalmente em machos confinados, tanto para produção de carne, quanto reprodutores de alto valor genético. A acidificação urinária é um dos métodos para prevenção desta enfermidade e pode ser realizada de forma eficaz com a suplementação de cloreto de amônio na dieta, que pode propiciar a instalação de acidose metabólica. A hemogasometria avalia o equilíbrio ácido-básico sanguíneo de forma prática e fácil. Neste trabalho, avaliou-se o efeito do cloreto de amônio sobre o equilíbrio ácido-básico e eletrolítico de ovinos em confinamento para quantificar a acidose metabólica desenvolvida. Utilizaram-se 100 ovinos, machos, confinados, com idade aproximada de três meses. Constituíram-se três grupos experimentais: Grupo I (n=40), recebeu 400mg/kg/PV de cloreto de amônio/animal/dia por 21 dias consecutivos, momento da interrupção da administração do acidificante urinário (M3) e continuidade do acompanhamento clinico até o final do experimento (M6); Grupo II (n=40), 400mg/kg/PV de cloreto de amônio/animal/dia por 42 dias consecutivos; Grupo III (n=20), não recebeu cloreto de amônio durante todo o período do experimento. Os Momentos (M) de colheita de amostras e avaliação clínica foram estabelecidos com intervalo de sete dias, sendo M0 (imediatamente antes do início do tratamento com cloreto de amônio), M1 (sete dias após), M2, M3, M4, M5 e M6, totalizando 56 dias de confinamento. A alimentação consistiu de ração total, composta por 15% de feno triturado e 85% de concentrado, água e sal mineral ad libitum. Após adaptação de 15 dias à dieta de confinamento, colheram-se de todos os animais amostras de urina para mensuração do pH, e sangue venoso para hemogasometria, nos diferentes momentos...

The incidence of obstructive urolithiasis in sheep is high, especially in feedlot males, both for meat production, or the breeder of high genetic value. The urinary acidification is one way to prevent this disease and can be performed effectively supplementation with ammonium chloride in the diet, which may facilitate the installation of metabolic acidosis. The blood gas analysis evaluates the acid-base balance of blood in a practical and easy way. In this study, it was evaluated the effect of ammonium chloride on acid-base and electrolyte in feedlot sheep blood gas analysis to determine the occurrence of metabolic acidosis. It was used 100 male lambs, in a feedlot, aged approximately three months. It was constituted three groups: Group I (n=40) that received 400mg/kg/PV of ammonium chloride/animal/day for 21 consecutive days, the time of discontinuation of the urinary acidifiers (M3) and continued clinical follow until the end of the experiment (M6); Group II (n=40), that received 400mg/kg/PV of ammonium chloride/animal/day for 42 consecutive days, Group III (n=20), that did not receive ammonium chloride throughout the experimental period. The moments (M) of samples and clinical assessment were established on seven days of interval, M0 (immediately before the beginning of the treatment with ammonium chloride), M1 (seven days after), M2, M3, M4, M5 and M6, totalizing 56 days of feedlot. The feed consisted of a total mixed ration consisting of 15% of ground hay and 85 % of concentrate, water and mineral salt ad libitum. After 15 days of adaptation to the diet of feedlot, urine samples for measurement of pH, and venous blood for blood gas analysis were collected from all animals at different moments. The urinary acidification was maintained as was the administration of ammonium chloride in GI and GII. The values of Na+ and K+ remained within the normal range for the species...

Impact of Plasma-Lyte pH 7.4 on acid-base status and hemodynamics in a model of controlled hemorrhagic shock

OBJECTIVE: Intravenous infusion of crystalloid solutions is a cornerstone of the treatment of hemorrhagic shock. However, crystalloid solutions can have variable metabolic acid-base effects, perpetuating or even aggravating shock-induced metabolic acidosis. The aim of this study was to compare, in a controlled volume-driven porcine model of hemorrhagic shock, the effects of three different crystalloid solutions on the hemodynamics and acid-base balance. METHODS: Controlled hemorrhagic shock (40 percent of the total blood volume was removed) was induced in 18 animals, which were then treated with normal saline (0.9 percent NaCl), Lactated Ringer's Solution or Plasma-Lyte pH 7.4, in a blinded fashion (n = 6 for each group). Using a predefined protocol, the animals received three times the volume of blood removed. RESULTS: The three different crystalloid infusions were equally capable of reversing the hemorrhage-induced low cardiac output and anuria. The Lactated Ringer's Solution and Plasma-Lyte pH 7.4 infusions resulted in an increased standard base excess and a decreased serum chloride level, whereas treatment with normal saline resulted in a decreased standard base excess and an increased serum chloride level. The Plasma-Lyte pH 7.4 infusions did not change the level of the unmeasured anions. CONCLUSION: Although the three tested crystalloid solutions were equally able to attenuate the hemodynamic and tissue perfusion disturbances, only the normal saline induced hyperchloremia and metabolic acidosis.

Cambios electroííticos y ácido-base en el paciete sometido a nefrectomia para donación renal en el centro médico quirúrgico Boliviano-belga / Electrolyte changes and acid-base in patients undergoing nephrectomy for kidney donation in the center medic-surgical Bolivian-Belgian

Los cambios en el equilibrio acido-base causados por la infusión de solución salina isotónica (0,9%) durante el transoperatorio han sido escasamente estudiados, por lo que en el presente estudio se evaluó este fenómeno en el paciente donador renal. Se realizó un estudio prospectivo, descriptivo, observacional y longitudinal donde se incluyeron 12 pacientes sometidos a nefrectomía dentro del protocolo de transplante renal de donador vivo relacionado que se lleva a cabo en el Centro Medico Quirúrgico Boliviano - Belga en el periodo comprendido entre Septiembre - Octubre de 2008. Se tomaron muestras de sangre de la arteria radial para medir pH, PaCO2, PAO2, concentraciones de sodio, potasio, cloro y bicarbonato séricos en 3 diferentes momentos del procedimiento quirúrgico-anestésico ( basal, pinzamiento y emersión ). El anión gap se calculó con la siguiente fórmula: [Na+] - [CI-] + [HCO3]. La infusión de solución salina isotónica (0.9%) causó disminución del pH, bicarbonato sérico y déficit de base (p < 0.001 ). El anión gap se mantuvo constante y el cloro sérico se incremento ligeramente sin mostrar significancia estadística. El tiempo de infusión fue de 14±24 min. Hasta el pinzamiento del hilio renal. La infusión de 15 ± 3.7 ml/kg/H de solución salina isotónica (0.9%) condujo a acidosis metabólica que asociada a hi-percloremia y a un anión gap normal se considera como acidosis hipercloremica.

The changes in acid-base balance caused by of a (0,9%) saline solution during anesthesia and surgery are poorly char-acterized. The authors evaluated these phenomena in kitney donors. It was carried out a prospective, descriptive, ob-servational and longitudinal study where 12 patients were included to nephrectomy protocol related to live donor's transplant that is taken to I dig in the Center I Prescribe Surgical Bolivian - Belgian in the period between September -October of 2008. We took samples of blood of the radial artery to measure pH, PaCO2, PAO2, concentrations of sodium, potassium, chlorine and bicarbonate serie in 3 different moments of the procedure surgical-anesthetic (basal,clamping and emersión). The anión gap was calculated with the following formula: [Na+] - [Cl -] + [HCO3 -]. The infusión of iso-tonic saline solution (0.9%) it caused decrease of the pH, bicarbonate serie and base déficit (p <0.001). The anión gap stayed constant and the chlorine serie increment lightly without statistical significance. The time of infusión was of 14±24 min. until the clamping of the renal hilio. The infusión of 15 ± 3.7 ml/kg/H of isotonic saline solution (0.9%) lead to metabolic acidosis associated to hyper-chloremia and to an normal anión gap it is considered as acidosis hyperchloremic.