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Changes in acid-base, electrolyte and hemoglobin concentrations during infusion of hydroxyethyl starch 130/0.42/6 : 1
Robert Sümpelmann1, Lars Witt, Meike Brütt
1Medizinische Hochschule Hannover, Klinik für Anästhesiologie und Intensivmedizin-OE 8050, Hanover, Germany. suempelmann.robert@mh-hannover.de
Insights
Using balanced hydroxyethyl starch (HES) solutions in children minimizes acid-base and electrolyte disturbances compared to normal saline HES. Balanced HES offers a safer perioperative fluid management strategy for pediatric patients.
Area of Science:
- Anesthesiology
- Pediatric Critical Care
- Pharmacology
Background:
- Balanced volume replacement strategies are crucial for hypovolemia correction.
- Third-generation hydroxyethyl starch (HES) is available in balanced electrolyte solutions.
- This study evaluates perioperative HES 130/0.42/6:1 in normal saline (ns-HES) versus balanced solution (bal-HES) in children.
Purpose of the Study:
- To compare the effects of ns-HES and bal-HES on acid-base, electrolyte, and hemoglobin levels in pediatric patients.
- To assess perioperative fluid management strategies in children undergoing surgery.
Main Methods:
- Prospective, non-interventional study of pediatric patients (up to 12 years, ASA I-III).
- Patients received either ns-HES or bal-HES perioperatively.
- Data collected included demographics, procedures, adverse events, hemodynamics, and blood gas analysis.
Main Results:
- Hemoglobin decreased in both groups post-infusion.
- Bicarbonate and base excess decreased with ns-HES but remained stable with bal-HES.
- Chloride concentrations increased significantly more with ns-HES compared to bal-HES.
Conclusions:
- Perioperative administration of hydroxyethyl starch in a balanced electrolyte solution minimizes iatrogenic acid-base and electrolyte alterations in children.
- Balanced HES is a preferred alternative to normal saline-based HES for pediatric fluid management.
Introduction:
A balanced volume replacement strategy is a well established concept for correcting hypovolemia using plasma adapted isotonic crystalloid solutions with a physiological electrolyte pattern and acetate as bicarbonate precursor. Recently, third-generation hydroxyethyl starch (HES) has also become available in a balanced electrolyte solution instead of normal saline. Therefore, in this prospective non-interventional clinical study, the perioperative administration of HES 130/0.42/6 : 1 in normal saline (ns-HES) and in balanced electrolyte solution (bal-HES) was evaluated in children with a focus on acid-base, electrolyte and hemoglobin changes.
Methods:
Following local ethics committee approval, pediatric patients aged up to 12 years with an ASA risk score of I-III undergoing perioperative administration of HES (ns-HES from May 2006 to December 2007, bal-HES from January 2008 to January 2009) were included. Patient demographics, the performed procedure, adverse drug reactions, hemodynamic data and the results of blood gas analysis were documented with a focus on changes in acid-base, electrolyte and hemoglobin concentrations.
Results:
Of 396 enrolled patients (ASA I-III; age 2.3 +/- 3, range day of birth - 12 years; body weight 10.8 +/- 9, range 0.9-52 kg), 249 received ns-HES and 147 bal-HES (mean volume infused 9.9 +/- 4 and 9.4 +/- 6.9 ml x kg(-1), respectively). After HES infusion, hemoglobin decreased in both groups, whereas bicarbonate and base excess (BE) decreased only with ns-HES and remained stable with bal-HES (BE before infusion: ns-HES -1.8 +/- 2.8, bal-HES -1.7 +/- 2.7 mmol x l(-1); after infusion: ns-HES -2.6 +/- 2.4; bal-HES -1.6 +/- 2.6 mmol x l(-1), P < 0.05). Chloride (Cl) concentrations increased in both groups and were significantly higher with ns-HES (Cl before infusion: ns-HES 105.6 +/- 3.7, bal-HES 105.1 +/- 2.8 mmol x l(-1); after infusion: ns-HES 107.7 +/- 3.2, bal-HES 106.3 +/- 2.9 mmol x l(-1), P < 0.01). No serious adverse drug reactions were observed.
Conclusion:
Infusion related iatrogenic acid-base and electrolyte alterations can be minimized by using hydroxyethyl starch in a balanced electrolyte solution instead of normal saline.
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