Nephrology Dialysis Transplantation, Vol 12, Issue 6 1212-1217, Copyright © 1997 by Oxford University Press
A Thomas, J Guy, R Kishen, I Geraghty, B Bowles and P Vadgama
Objective. To compare acid-base balance, lactate
concentration, and haemodynamic and O2 transport variables during
haemofiltration with replacement fluid containing 44.5 mmol/l
Na+ lactate or 40 mmol/l Na+
HCO3- and 3 mmol/l lactic acid.
Design. A prospective, randomized trial.
Setting. A multidisciplinary, adult intensive care
unit in a university hospital. Patients. Forty
acidotic patients who required haemofiltration, were dependent on
mechanical ventilation, and had PA catheters in situ.
Interventions. During haemofiltration patients
received lactate or bicarbonate replacement fluid at a mean rate of 1.71/h
(SD 0.3). Arterial blood gases, plasma lactate, and haemodynamic and O2
transport variables were measured before and after 12 and 24 h
haemofiltration. Ultrafiltrate was collected for lactate estimation.
Measurements and main results. As means (SD). The net
gain of lactate was 63 mmol/h (12 mmol) with Na+
lactate and 0 mmol/h (0.3 mmol) with Na+
HCO3-. There was a significant increase in pH and
[lactate] in both groups, but [lactate] was higher in patients receiving
lactate. Twenty-one patients survived to ICU discharge, these patients were
significantly less acidotic after filtration (lactate
group: 0 h: pH 7.23 (0.09), [lactate] 2.4 mmol/l (1.7); 12 h: pH
7.34 (0.09), [lactate] 4.7 mmol/l (2.4); 24 h: pH 7.36 (0.07), [lactate]
4.7 mmol (2.7). HCO3 group: 0 h:
pH 7.23 (0.09), [lactate] 2.3 (1.3); 12 h: pH 7.32 (0.06), [lactate] 2.9
mmol/l (1.8); 24 h pH 7.35 (0.08), [lactate] 2.8 mmol/l (2.0).
Base deficit: survivors: 0 h: 9 mmol/l (4); 12 h: 2
mmol/l (3). Non-survivors: 0 h: 10 mmol/l (3); 12 h: 6
mmol/l (3)). Haemodynamic and O2 transport variables were not significantly
affected by treatment group or outcome. Conclusions.
The degree of correction of acidosis during the first 24 h of
haemofiltration was determined by patients outcome but was not affected by
the substitution of bicarbonate- for lactate-containing replacement fluids.
Keywords: acidosis; bicarbonate; critical illness;
haemofiltration; lactate
ORIGINAL ARTICLES
Comparison of lactate and bicarbonate buffered haemofiltration fluids: use in critically ill patients
Departments of Intensive Care and Chemical Pathology, Hope Hospital, Salford, UK; Corresponding author address: c/o Department of Anaesthesia, Hope Hospital, Stott Lane, Salford M6 8HD, UK
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