Effects of Ringer's lactate or Ringerfundin resuscitation on the acid–base status and serum electrolytes in septic oncologic patients

Introduction

Administration of resuscitation fluids has been associated with the development of metabolic and electrolytic disturbances. The duration and severity of such metabolic acidosis appear to depend on many factors, and the acidosis may continue for hours after the initial intervention. It is unknown whether different types of fluids may affect such changes differently. Ringerfundin is a recently developed crystalloid with similar properties to human plasma, perhaps resulting in less electrolytic and acid–basic disorders. Accordingly, we conducted a randomized controlled study of fluid resuscitation in a clinical oncologic ICU. The aim of this study was to determine the effects of resuscitation on patients' electrolyte concentrations and acid–base status.

Methods

Forty patients in the first hours after diagnosis of septic shock (early hours) were randomized to receive solutions of either Ringer's lactate (n = 20) or Ringerfundin (n = 20) for fluid resuscitation. The amount of fluid needed to reach the goals of therapy was compared between groups. Also, bicarbonate, base excess, pH, chloride, sodium, potassium, calcium, magnesium, albumin, anion gap, SIDe, SIG and lactate were compared at baseline, 2 hours after initial therapy, 6 hours after and 24 hours after.

Results

There were no differences in demographic, baseline characteristics, electrolytic and acid–basic status of the groups before therapy. After randomization, bicarbonate and base excess increased significantly at 2 hours and 6 hours in the Ringerfundin group compared with Ringer's lactate group (P < 0.0001). Patients who received Ringer's lactate presented a significantly greater increase in serum chloride (P < 0.002) and a lower clearance of lactate after 2 hours, 6 hours and 24 hours (P < 0.002). There were no differences in amount of fluid needed, SIG, SIDe and anion gap between groups.

Conclusion

When comparing Ringer's lactate and Ringerfundin, the choice of resuscitation fluid is an independent predictor of acid–base status and serum electrolytes. Ringerfundin administration was associated with a better preservation of electrolytic and acid–basic pattern.