title: [Bicarbonate instead of lactate buffered substitution solution for continuous hemofiltration in intensive care].
abstract: The substitution fluids applied in continuous haemofiltration contain 40 mmol/l of lactate. This is unphysiological, since administration of large amounts of lactate lowers the phosphorylation potential and increases catabolism. With bicarbonate-buffered fluid three problems may arise: 1. Precipitation of calcium carbonate and magnesium carbonate; 2. pH is usually 8.4; 3. evaporation of CO2 increases pH. To solve these problems we applied a two-component system consisting of a glass bottle with 160 ml sodium bicarbonate 8.4% and a bag with 4.5 l of acidic solution. Prior to use, the bicarbonate was infused into the bag. The values of Ca++, Mg++, bicarbonate, and pH in this final substitution solution were constant during a 24 hr period after mixing. Precipitation of Ca++ and Mg++ carbonate was prevented by 3 mmol/l of lactic acid in the solution. The pH was 7.37. Evaporation of CO2 was prevented by bags made of special plastic sheeting. The solution was then applied in 7 intensive-care patients suffering from acute renal failure treated by continuous arteriovenous haemofiltration. No side effects of the solution were observed during six days of treatment. The values of Ca++, bicarbonate, pH, and pCO2 remained constant under clinical routine conditions. Hence, bicarbonate-buffered substitution solution is recommended for continuous haemofiltration. Continuous haemofiltration is now also available for patients with impaired liver function and increased lactate levels.
authors.affiliation: Abteilung Nephrologie, Medizinische Hochschule Hannover.
authors.forename: C J
authors.initials: CJ
authors.lastname: Olbricht
authors.forename: D
authors.initials: D
authors.lastname: Huxmann-Nägeli
authors.forename: H
authors.initials: H
authors.lastname: Bischoff
mesh_terms: D000136:Acid-Base Equilibrium / Q000187:drug effects*; D058186:Acute Kidney Injury / Q000097:blood / Q000628:therapy*; D000328:Adult; D000368:Aged; D001639:Bicarbonates / Q000008:administration & dosage*; D003422:Critical Care; D004573:Electrolytes / Q000097:blood; D006440:Hemofiltration / Q000379:methods*; D006801:Humans; D007773:Lactates / Q000008:administration & dosage*; D019344:Lactic Acid; D008875:Middle Aged; D011183:Postoperative Complications / Q000097:blood / Q000628:therapy*
chemical_list: D001639:Bicarbonates; D004573:Electrolytes; D007773:Lactates; D019344:Lactic Acid
vernacular_title: Bikarbonat- statt laktatgepufferter Substitutionslösung zur kontinuierlichen Hämofiltration im Intensivbereich.