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The rule regulating pH changes during crystalloid infusion.

E Carlesso1, G Maiocchi, F Tallarini

  • 1Dipartimento di Anestesiologia, Terapia Intensiva e Scienze Dermatologiche, Università degli Studi, Milan, Italy.

Intensive Care Medicine
|December 15, 2010
PubMed
Summary
This summary is machine-generated.

The strong ion difference (SID) of crystalloid solutions determines their effect on human plasma acid-base balance. Matching the crystalloid SID to the baseline bicarbonate concentration maintains stable pH during infusion.

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Area of Science:

  • Biochemistry
  • Physiology
  • Medical Science

Background:

  • Acid-base balance is crucial for physiological function.
  • Crystalloid solutions are commonly used in fluid resuscitation.
  • Understanding how crystalloids affect acid-base status is clinically important.

Purpose of the Study:

  • To establish the rule governing how crystalloid solutions with varying strong ion difference (SID) impact human plasma acid-base variables.
  • To define the relationship between crystalloid SID and plasma pH, bicarbonate, and PCO₂.

Main Methods:

  • A validated software was used to compute the effects of diluting human plasma with crystalloid solutions of varying SID.
  • An equation was derived to calculate the SID required to maintain baseline pH at constant PCO₂.
  • Experimental validation was performed using fresh frozen plasma infused with crystalloid solutions of different SIDs.

Main Results:

  • Mathematical analysis revealed that the diluent SID needed to maintain baseline pH equals the baseline bicarbonate concentration ([HCO₃⁻]) at constant PCO₂.
  • Experimental data confirmed this finding, showing stable pH when diluent SID matched baseline [HCO₃⁻].
  • Infusion with SIDs lower or higher than baseline [HCO₃⁻] resulted in decreased or increased pH, respectively.

Conclusions:

  • Baseline bicarbonate concentration is the primary determinant of the pH response to crystalloid infusion.
  • Crystalloid solutions with SID equal to baseline [HCO₃⁻] maintain pH homeostasis at constant PCO₂.
  • Deviations in crystalloid SID from baseline [HCO₃⁻] predictably alter plasma pH.