Deakin University
Browse

File(s) not publicly available

The impact of lactate-buffered high-volume hemofiltration on acid-base balance

journal contribution
posted on 2003-07-01, 00:00 authored by L Cole, R Bellomo, Ian BaldwinIan Baldwin, M Hayhoe, C Ronco
Objective: To evaluate the effect of high-volume hemofiltration (HVHF) with lactate-buffered replacement fluids on acid-base balance. Design: Randomized crossover study. Setting: Intensive Care Unit of Tertiary Medical Center. Participants: Ten patients with septic shock and acute renal failure. Interventions: Random allocation to 8 h of isovolemic high-volume hemofiltration (ultrafiltration rate: 6 1/h) or 8 h of isovolemic continuous venovenous hemofiltration (ultrafiltration rate: 1 1/h) with lactate-buffered replacement fluid with subsequent crossover. Measurements and results: We measured blood gases, electrolytes, albumin, and lactate concentrations and completed quantitative biophysical analysis of acid-base balance changes. Before high-volume hemofiltration, patients had a slight metabolic alkalosis [pH: 7.42; base excess (BE) 2.4 mEq/1] despite hyperlactatemia (lactate: 2.51 mmol/1). After 2 h of high-volume hemofiltration, the mean lactate concentration increased to 7.30 mmol/1 (p=0.0001). However, a decrease in chloride, strong ion difference effective, and strong ion gap (SIG) compensated for the effect of iatrogenic hyperlactatemia so that the pH only decreased to 7.39 (p=0.05) and the BE to -0.15 (p=0.001). After 6 h, despite persistent hyperlactatemia (7 mmol/1), the pH had returned to 7.42 and the BE to 2.45 mEq/1. These changes remained essentially stable at 8 h. Similar but less intense changes occurred during continuous venovenous hemofiltration. Conclusions: HVHF with lactate-buffered replacement fluids induces iatrogenic hyperlactatemia. However, such hyperlactatemia only has a mild and transient acidifying effect. A decrease in chloride and strong ion difference effective and the removal of unmeasured anions all rapidly compensate for this effect.

History

Journal

Intensive Care Medicine

Volume

29

Issue

7

Pagination

1113 - 1120

ISSN

0342-4642

Usage metrics

    Research Publications

    Categories

    No categories selected

    Keywords

    Exports

    RefWorks
    BibTeX
    Ref. manager
    Endnote
    DataCite
    NLM
    DC