Equivalent metabolic acidosis with four colloids and saline on ex vivo haemodilution

Morgan, T. J., Vellaichamy, M., Cowley, D. M., Weier, S. L., Venkatesh, B. and Jones, M. A. (2009) Equivalent metabolic acidosis with four colloids and saline on ex vivo haemodilution. Anaesthesia and Intensive Care, 37 3: 407-414.

Author Morgan, T. J.
Vellaichamy, M.
Cowley, D. M.
Weier, S. L.
Venkatesh, B.
Jones, M. A.
Title Equivalent metabolic acidosis with four colloids and saline on ex vivo haemodilution
Journal name Anaesthesia and Intensive Care   Check publisher's open access policy
ISSN 0310-057X
Publication date 2009-05
Sub-type Article (original research)
Volume 37
Issue 3
Start page 407
End page 414
Total pages 8
Place of publication Melbourne, Australia
Publisher Australian Association of Anaesthetists
Language eng
Subject 1103 Clinical Sciences
Abstract Colloid infusions can cause metabolic acidosis. Mechanisms and relative severity with different colloids are incompletely understood. We compared haemodilution acid-base effects of 4% albumin, 3.5% polygeline, 4% succinylated gelatin (all weak acid colloids, strong ion difference 12 mEq/l, 17.6 mEq/l and 34 mEq/l respectively), 6% hetastarch (non-weak acid colloid, strong ion difference zero) and 0.9% saline (crystalloid, strong ion difference zero). Gelatin weak acid properties were tracked via the strong ion gap. Four-step ex vivo dilutions of pre-oxygenated human venous blood were performed to a final [Hb] near 50% baseline. With each fluid, base excess fell to approximately -13 mEq/l. Base excess/[Hb] relationships across dilution were linear and direct (R2 ≥0.96), slopes and intercepts closely resembling saline. Baseline strong ion gap was -0.3 (2.1) mEq/l. Post-dilution increases occurred in three groups: small with saline, hetastarch and albumin (to 3.5 (02) mEq/l, 4.3 (0.3) mEq/l, 3.3 (1.4) mEq/l respectively), intermediate with polygeline (to 12.2 (0.9) mEq/l) and greatest with succinylated gelatin (to 20.8 (1.4) mEq/l). We conclude that, despite colloid weak acid activity ranging from zero (hydroxyethyl starch) to greater than that of albumin with both gelatin preparations, ex vivo dilution causes a metabolic acidosis of identical severity to saline in each case. This uniformity reflects modifications to the albumin and gelatin saline vehicles, in part aimed at pH correction. By proportionally increasing the strong ion difference, these modifications counter deviations from pure saline effects caused by colloid weak acid activity. Extrapolation in vivo requires further investigation.
Keyword colloid
Q-Index Code C1
Q-Index Status Provisional Code
Institutional Status UQ

Document type: Journal Article
Sub-type: Article (original research)
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Created: Thu, 03 Sep 2009, 08:07:49 EST by Mr Andrew Martlew on behalf of Faculty Of Health Sciences