Effect of volume loading with 1 liter intravenous infusions of 0.9% saline, 4% succinylated gelatine (Gelofusine) and 6% hydroxyethyl starch (Voluven) on blood volume and endocrine responses: a randomized, three-way crossover study in healthy volunteers.
OBJECTIVE
To study the changes in blood volume and hormones controlling sodium and water homeostasis after infusions of 0.9% saline, Gelofusine (4% succinylated gelatin in 0.7% saline, weight-average molecular weight 30 kD), and Voluven (6% hydroxyethyl starch in 0.9% saline, weight-average molecular weight 130 kD) in healthy volunteers.


METHODS
Randomized, three-way crossover study.


METHODS
University teaching hospital.


METHODS
Ten healthy adult male volunteers.


METHODS
Volunteers received 1-L infusions of 0.9% saline, Gelofusine, and Voluven over 1 hr on three occasions. Body weight, hematocrit, serum biochemistry, and plasma concentrations of vasopressin, aldosterone, brain natriuretic peptide, and total renin were measured before infusion and hourly thereafter for 6 hrs. Changes in body water, blood volume, and extravascular fluid volume were calculated.


RESULTS
Although changes in body weight (total body water) after the infusions were similar, blood volume expansion by the two colloids was significantly greater than that produced by 0.9% saline (p < .01). At the end of infusions, 68%, 21%, and 16% of the infused volumes of 0.9% saline, Gelofusine, and Voluven, respectively, had escaped from the intravascular space to the extravascular space. Over the 6 hrs, the magnitude and duration of blood volume expansion by the two colloids were similar (p = .70). There were no significant differences in urinary volume, osmolality, and sodium content after the three infusions. Hormonal changes were similar after the three infusions, with the increase in natriuretic peptide being transient. The reduction in aldosterone and total renin concentrations was more sustained.


CONCLUSIONS
The effects of Gelofusine and Voluven were similar despite the 100 kD difference in weight-average molecular weight. Excretion of an acute fluid load containing sodium and chloride may be dependent on a sustained suppression of the renin-angiotensin-aldosterone system rather than on natriuretic peptides.
Division of Gastrointestinal Surgery, Nottingham Digestive Diseases Centre NIHR Biomedical Research Unit, Nottingham University Hospitals, Queen's Medical Centre, Nottingham, UK. Dileep.Lobo@nottingham.ac.uk
Dileep N
DN
Lobo
Zeno
Z
Stanga
Mark M
MM
Aloysius
Catherine
C
Wicks
Quentin M
QM
Nunes
Katharine L
KL
Ingram
Lorenz
L
Risch
Simon P
SP
Allison
D000328:Adult; D000450:Aldosterone / Q000097:blood; D001810:Blood Volume / Q000187:drug effects* / Q000502:physiology; D001834:Body Water / Q000187:drug effects; D018592:Cross-Over Studies; D006400:Hematocrit; D006801:Humans; D006895:Hydroxyethyl Starch Derivatives / Q000008:administration & dosage / Q000494:pharmacology*; D007262:Infusions, Intravenous; D008297:Male; D020097:Natriuretic Peptide, Brain / Q000097:blood; D010952:Plasma Substitutes / Q000008:administration & dosage / Q000494:pharmacology*; D011097:Polygeline / Q000008:administration & dosage / Q000494:pharmacology*; D012083:Renin / Q000097:blood; D012965:Sodium Chloride / Q000008:administration & dosage / Q000494:pharmacology*; D014667:Vasopressins / Q000097:blood; D014882:Water-Electrolyte Balance / Q000187:drug effects / Q000502:physiology
D006895:Hydroxyethyl Starch Derivatives; D010952:Plasma Substitutes; D014667:Vasopressins; D020097:Natriuretic Peptide, Brain; D012965:Sodium Chloride; D000450:Aldosterone; D011097:Polygeline; D012083:Renin