title: Rapid saline infusion produces hyperchloremic acidosis in patients undergoing gynecologic surgery.
abstract: BACKGROUND
  Changes in acid-base balance caused by infusion of a 0.9% saline solution during anesthesia and surgery are poorly characterized. Therefore, the authors evaluated these phenomena in a dose-response study.
  
  
  METHODS
  Two groups of 12 patients each who were undergoing major intraabdominal gynecologic surgery were assigned randomly to receive 0.9% saline or lactated Ringer's solution in a dosage of 30 ml x kg(-1) x h(-1). The pH, arterial carbon dioxide tension, and serum concentrations of sodium, potassium, chloride, lactate, and total protein were measured in 30-min intervals. The serum bicarbonate concentration was calculated using the Henderson-Hasselbalch equation and also using the Stewart approach from the strong ion difference and the amount of weak plasma acid. The strong ion difference was calculated as serum sodium + serum potassium - serum chloride - serum lactate. The amount of weak plasma acid was calculated as the serum total protein concentration in g/dl x 2.43.
  
  
  RESULTS
  Infusion of 0.9% saline, but not lactated Ringer's solution, caused a metabolic acidosis with hyperchloremia and a concomitant decrease in the strong ion difference. Calculating the serum bicarbonate concentration using the Henderson-Hasselbalch equation or the Stewart approach produced equivalent results.
  
  
  CONCLUSIONS
  Infusion of approximately 30 ml x kg(-1) x h(-1) saline during anesthesia and surgery inevitably leads to metabolic acidosis, which is not observed after administration of lactated Ringer's solution. The acidosis is associated with hyperchloremia.
mesh_terms: D000138:Acidosis / Q000209:etiology*; D000328:Adult; D000368:Aged; D001639:Bicarbonates / Q000097:blood; D002712:Chlorides / Q000097:blood*; D005260:Female; D006801:Humans; D007431:Intraoperative Complications / Q000209:etiology*; D007552:Isotonic Solutions / Q000009:adverse effects; D008875:Middle Aged; D000077325:Ringer's Lactate; D012965:Sodium Chloride / Q000009:adverse effects*