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Vol. 45. Issue 7.
Pages 421-430 (October 2021)
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Vol. 45. Issue 7.
Pages 421-430 (October 2021)
Original
DOI: 10.1016/j.medine.2020.04.002
Effect of half-molar sodium lactate infusion on biochemical parameters in critically ill patients
Efecto de la infusión de lactato de sodio 0,5 molar sobre el medio interno de pacientes críticos
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I. Aramendia,
Corresponding author
nachoaramendi@gmail.com

Corresponding author.
, A. Stolovasa, S. Mendañaa, A. Barindellib, W. Manzanaresa, A. Biestroa
a Cátedra de Medicina Intensiva, Centro de Tratamiento Intensivo, Hospital de Clínicas Dr. Manuel Quintela, Facultad de Medicina, Universidad de la República (UdelaR), Montevideo, Uruguay
b Laboratorio Clínico, Hospital de Clínicas Dr. Manuel Quintela, Facultad de Medicina, Universidad de la República (UdelaR), Montevideo, Uruguay
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Tables (5)
Table 1. Biochemical characteristics of half-molar sodium lactate.
Table 2. Demographic and baseline characteristics of the patients included in the study.
Table 3. Time course of the different biochemical parameters during the study.
Table 4. Time course of the acid–base balance parameters in patients with hyperlactatemia (lactate >2mmol/l) prior to the infusion of HSL 0.5M.
Table 5. Time course of MBP, ICP and BPP in 19 patients administered HSL 0.5M as osmotic agent.
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Abstract
Objective

To evaluate the impact of the infusion of sodium lactate 500ml upon different biochemical variables and intracranial pressure in patients admitted to the intensive care unit.

Design

A prospective experimental single cohort study was carried out.

Scope

Polyvalent intensive care unit of a university hospital.

Patients

Critical patients with shock and intracranial hypertension.

Procedure

A 500ml sodium lactate bolus was infused in 15min. Plasma levels of sodium, potassium, magnesium, calcium, chloride, lactate, bicarbonate, PaCO2, pH, phosphate and albumin were recorded at 3 timepoints: T0 pre-infusion; T1 at 30min, and T2 at 60min post-infusion. Mean arterial pressure and intracranial pressure were measured at T0 and T2.

Results

Forty-one patients received sodium lactate: 19 as an osmotically active agent and 22 as a volume expander. Metabolic alkalosis was observed: T0 vs. T1 (p=0.007); T1 vs. T2 (p=0.003). Sodium increased at the 3 timepoints (T0 vs. T1, p<0.0001; T1 vs. T2, p=0.0001). In addition, sodium lactate decreased intracranial pressure (T0: 24.83±5.4 vs. T2: 15.06±5.8; p<0.001). Likewise, plasma lactate showed a biphasic effect, with a rapid decrease at T2 (p<0.0001), including in those with previous hyperlactatemia (p=0.002).

Conclusions

The infusion of sodium lactate is associated to metabolic alkalosis, hypernatremia, reduced chloremia, and a biphasic change in plasma lactate levels. Moreover, a decrease in intracranial pressure was observed in patients with acute brain injury.

Keywords:
Sodium lactate
Fluid therapy
Hyperchloremia
Osmotherapy
Intracranial hypertension
Resumen
Objetivo

Evaluar el impacto de la infusión de lactato de sodio 0,5M sobre variables del medio interno y sobre la presión intracraneana en pacientes críticos.

Diseño

Estudio prospectivo experimental de cohorte única.

Ámbito

Unidad de cuidados intensivos de un hospital universitario.

Pacientes

Pacientes con shock y neurocríticos con hipertensión intracraneana.

Intervenciones

Se infundió una carga de 500 cc de infusión de lactato de sodio 0,5M en 15min y se midió el nivel plasmático de sodio, potasio, magnesio, calcio, cloro, lactato, bicarbonato, PaCO2 arterial, pH, fosfato y albúmina en 3 tiempos: T0 preinfusión; T1 a los 30min y T2 a los 60min postinfusión. Se midieron la presión arterial media y presión intracraneana en T0 y T2.

Resultados

Recibieron el fluido N=41: n=19 como osmoagente y 22 como expansor. Se constató alcalosis metabólica: T0 vs. T1 (p=0,007); T1 vs. T2 (p=0,003). La natremia aumentó en los 3 tiempos (T0 vs. T1; p<0,0001; T1 vs. T2; p=0,0001). Se demostró un descenso de la presión intracraneana (T0: 24,83±5,4 vs. T2: 15,06±5,8; p<0,001). El lactato aumentó inicialmente (T1) con un rápido descenso (T2) (p<0,0001), incluso en aquellos pacientes con hiperlactatemia basal (p=0,002).

Conclusiones

La infusión de lactato de sodio 0,5M genera alcalosis metabólica, hipernatremia, disminución de la cloremia y un cambio bifásico del lactato, y muestra eficacia en el descenso de la presión intracraneana en pacientes con daño encefálico agudo.

Palabras clave:
Lactato de sodio
Fluidoterapia
Alcalosis metabólica
Hipercloremia
Hipertensión intracraneana

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