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Changes in acid-base, electrolyte and hemoglobin concentrations during infusion of hydroxyethyl starch 130/0.42/6 : 1 in normal saline or in balanced electrolyte solution in children.
Paediatr Anaesth. 2010 Jan; 20(1):100-4.PA

Abstract

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.

Authors+Show Affiliations

Medizinische Hochschule Hannover, Klinik für Anästhesiologie und Intensivmedizin-OE 8050, Hanover, Germany. suempelmann.robert@mh-hannover.deNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Clinical Trial
Journal Article

Language

eng

PubMed ID

19968805

Citation

Sümpelmann, Robert, et al. "Changes in Acid-base, Electrolyte and Hemoglobin Concentrations During Infusion of Hydroxyethyl Starch 130/0.42/6 : 1 in Normal Saline or in Balanced Electrolyte Solution in Children." Paediatric Anaesthesia, vol. 20, no. 1, 2010, pp. 100-4.
Sümpelmann R, Witt L, Brütt M, et al. Changes in acid-base, electrolyte and hemoglobin concentrations during infusion of hydroxyethyl starch 130/0.42/6 : 1 in normal saline or in balanced electrolyte solution in children. Paediatr Anaesth. 2010;20(1):100-4.
Sümpelmann, R., Witt, L., Brütt, M., Osterkorn, D., Koppert, W., & Osthaus, W. A. (2010). Changes in acid-base, electrolyte and hemoglobin concentrations during infusion of hydroxyethyl starch 130/0.42/6 : 1 in normal saline or in balanced electrolyte solution in children. Paediatric Anaesthesia, 20(1), 100-4. https://doi.org/10.1111/j.1460-9592.2009.03197.x
Sümpelmann R, et al. Changes in Acid-base, Electrolyte and Hemoglobin Concentrations During Infusion of Hydroxyethyl Starch 130/0.42/6 : 1 in Normal Saline or in Balanced Electrolyte Solution in Children. Paediatr Anaesth. 2010;20(1):100-4. PubMed PMID: 19968805.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Changes in acid-base, electrolyte and hemoglobin concentrations during infusion of hydroxyethyl starch 130/0.42/6 : 1 in normal saline or in balanced electrolyte solution in children. AU - Sümpelmann,Robert, AU - Witt,Lars, AU - Brütt,Meike, AU - Osterkorn,Dirk, AU - Koppert,Wolfgang, AU - Osthaus,Wilhelm A, Y1 - 2009/11/23/ PY - 2009/12/9/entrez PY - 2009/12/9/pubmed PY - 2010/3/26/medline SP - 100 EP - 4 JF - Paediatric anaesthesia JO - Paediatr Anaesth VL - 20 IS - 1 N2 - 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. SN - 1460-9592 UR - https://www.unboundmedicine.com/medline/citation/19968805/Changes_in_acid_base_electrolyte_and_hemoglobin_concentrations_during_infusion_of_hydroxyethyl_starch_130/0_42/6_:_1_in_normal_saline_or_in_balanced_electrolyte_solution_in_children_ L2 - https://doi.org/10.1111/j.1460-9592.2009.03197.x DB - PRIME DP - Unbound Medicine ER -