title: Equivalent metabolic acidosis with four colloids and saline on ex vivo haemodilution.
abstract: Colloid infusions can cause metabolic acidosis. Mechanisms and relative severity with different colloids are incompletely understood. We compared haemodilution acid-base effects of 4% albumin, 3.5% polygeline, 4% succinylated gelatin (all weak acid colloids, strong ion difference 12 mEq/l, 17.6 mEq/l and 34 mEq/l respectively), 6% hetastarch (non-weak acid colloid, strong ion difference zero) and 0.9% saline (crystalloid, strong ion difference zero). Gelatin weak acid properties were tracked via the strong ion gap. Four-step ex vivo dilutions of pre-oxygenated human venous blood were performed to a final [Hb] near 50% baseline. With each fluid, base excess fell to approximately -13 mEq/l. Base excess/[Hb] relationships across dilution were linear and direct (R2 > or = 0.96), slopes and intercepts closely resembling saline. Baseline strong ion gap was -0.3 (2.1) mEq/l. Post-dilution increases occurred in three groups: small with saline, hetastarch and albumin (to 3.5 (02) mEq/l, 4.3 (0.3) mEq/l, 3.3 (1.4) mEq/l respectively), intermediate with polygeline (to 12.2 (0.9) mEq/l) and greatest with succinylated gelatin (to 20.8 (1.4) mEq/l). We conclude that, despite colloid weak acid activity ranging from zero (hydroxyethyl starch) to greater than that of albumin with both gelatin preparations, ex vivo dilution causes a metabolic acidosis of identical severity to saline in each case. This uniformity reflects modifications to the albumin and gelatin saline vehicles, in part aimed at pH correction. By proportionally increasing the strong ion difference, these modifications counter deviations from pure saline effects caused by colloid weak acid activity. Extrapolation in vivo requires further investigation.
authors.affiliation: Adult Intensive Care Unit and Department of Chemical Pathology, Mater Health Services, Brisbane, Queensland, Australia.
authors.forename: T J
authors.initials: TJ
authors.lastname: Morgan
authors.forename: M
authors.initials: M
authors.lastname: Vellaichamy
authors.forename: D M
authors.initials: DM
authors.lastname: Cowley
authors.forename: S L
authors.initials: SL
authors.lastname: Weier
authors.forename: B
authors.initials: B
authors.lastname: Venkatesh
authors.forename: M A
authors.initials: MA
authors.lastname: Jones
mesh_terms: D000136:Acid-Base Equilibrium / Q000187:drug effects*; D000138:Acidosis / Q000139:chemically induced*; D000418:Albumins / Q000633:toxicity; D003102:Colloids / Q000737:chemistry / Q000633:toxicity; D005780:Gelatin / Q000633:toxicity; D006438:Hemodilution / Q000379:methods*; D006801:Humans; D006863:Hydrogen-Ion Concentration; D006895:Hydroxyethyl Starch Derivatives / Q000633:toxicity; D066298:In Vitro Techniques; D010952:Plasma Substitutes / Q000737:chemistry / Q000633:toxicity; D011097:Polygeline / Q000633:toxicity; D012720:Severity of Illness Index; D012965:Sodium Chloride / Q000633:toxicity; D013386:Succinates / Q000633:toxicity
chemical_list: D000418:Albumins; D003102:Colloids; D006895:Hydroxyethyl Starch Derivatives; D010952:Plasma Substitutes; D013386:Succinates; C060085:succinylated gelatin; D012965:Sodium Chloride; D005780:Gelatin; D011097:Polygeline