| The impact of lactate-buffered high-volume hemofiltration on acid-base balance. | |
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MedLine Citation:
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PMID: 12783161 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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OBJECTIVE: To evaluate the effect of high-volume hemofiltration (HVHF) with lactate-buffered replacement fluids on acid-base balance. DESIGN: Randomized crossover study. SETTING: Intensive Care Unit of Tertiary Medical Center PARTICIPANTS: Ten patients with septic shock and acute renal failure. INTERVENTIONS: Random allocation to 8 h of isovolemic high-volume hemofiltration (ultrafiltration rate: 6 l/h) or 8 h of isovolemic continuous venovenous hemofiltration (ultrafiltration rate: 1 l/h) with lactate-buffered replacement fluid with subsequent crossover. MEASUREMENTS AND RESULTS: We measured blood gases, electrolytes, albumin, and lactate concentrations and completed quantitative biophysical analysis of acid-base balance changes. Before high-volume hemofiltration, patients had a slight metabolic alkalosis [pH: 7.42; base excess (BE) 2.4 mEq/l] despite hyperlactatemia (lactate: 2.51 mmol/l). After 2 h of high-volume hemofiltration, the mean lactate concentration increased to 7.30 mmol/l ( p=0.0001). However, a decrease in chloride, strong ion difference effective, and strong ion gap (SIG) compensated for the effect of iatrogenic hyperlactatemia so that the pH only decreased to 7.39 ( p=0.05) and the BE to -0.15 ( p=0.001). After 6 h, despite persistent hyperlactatemia (7 mmol/l), the pH had returned to 7.42 and the BE to 2.45 mEq/l. These changes remained essentially stable at 8 h. Similar but less intense changes occurred during continuous venovenous hemofiltration. CONCLUSIONS: HVHF with lactate-buffered replacement fluids induces iatrogenic hyperlactatemia. However, such hyperlactatemia only has a mild and transient acidifying effect. A decrease in chloride and strong ion difference effective and the removal of unmeasured anions all rapidly compensate for this effect. |
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Authors:
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Louise Cole; Rinaldo Bellomo; Ian Baldwin; Matthew Hayhoe; Claudio Ronco |
Publication Detail:
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Type: Clinical Trial; Journal Article; Randomized Controlled Trial; Research Support, Non-U.S. Gov't Date: 2003-05-29 |
Journal Detail:
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Title: Intensive care medicine Volume: 29 ISSN: 0342-4642 ISO Abbreviation: Intensive Care Med Publication Date: 2003 Jul |
Date Detail:
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Created Date: 2003-07-09 Completed Date: 2003-12-09 Revised Date: 2006-11-15 |
Medline Journal Info:
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Nlm Unique ID: 7704851 Medline TA: Intensive Care Med Country: United States |
Other Details:
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Languages: eng Pagination: 1113-20 Citation Subset: IM |
Affiliation:
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Department of Intensive Care, Austin and Repatriation Medical Centre, Studley Road, 3084, Heidelberg, Victoria, Australia. |
Export Citation:
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APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
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Acid-Base Equilibrium* Cross-Over Studies Hemofiltration / methods* Humans Hydrogen-Ion Concentration Kidney Failure, Acute / therapy Lactates* Shock, Septic / therapy |
| Chemical | |
Reg. No./Substance:
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0/Lactates |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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