Infusion fluids contain harmful glucose degradation products.
OBJECTIVE
Glucose degradation products (GDPs) are precursors of advanced glycation end products (AGEs) that cause cellular damage and inflammation. We examined the content of GDPs in commercially available glucose-containing infusion fluids and investigated whether GDPs are found in patients' blood.


METHODS
The content of GDPs was examined in infusion fluids by high-performance liquid chromatography (HPLC) analysis. To investigate whether GDPs also are found in patients, we included 11 patients who received glucose fluids (standard group) during and after their surgery and 11 control patients receiving buffered saline (control group). Blood samples were analyzed for GDP content and carboxymethyllysine (CML), as a measure of AGE formation. The influence of heat-sterilized fluids on cell viability and cell function upon infection was investigated.


RESULTS
All investigated fluids contained high concentrations of GDPs, such as 3-deoxyglucosone (3-DG). Serum concentration of 3-DG increased rapidly by a factor of eight in patients receiving standard therapy. Serum CML levels increased significantly and showed linear correlation with the amount of infused 3-DG. There was no increase in serum 3-DG or CML concentrations in the control group. The concentration of GDPs in most of the tested fluids damaged neutrophils, reducing their cytokine secretion, and inhibited microbial killing.


CONCLUSIONS
These findings indicate that normal standard fluid therapy involves unwanted infusion of GDPs. Reduction of the content of GDPs in commonly used infusion fluids may improve cell function, and possibly also organ function, in intensive-care patients.
Bryland
Anna
A
Department of Nephrology, Lund University, Lund, Sweden.
Broman
Marcus
M
Erixon
Martin
M
Klarin
Bengt
B
Lindén
Torbjörn
T
Friberg
Hans
H
Wieslander
Anders
A
Kjellstrand
Per
P
Ronco
Claudio
C
Carlsson
Ola
O
Godaly
Gabriela
G
D003422:Critical Care / Q000379:methods; D004340:Drug Contamination; D005260:Female; D005440:Fluid Therapy / Q000379:methods*; D005947:Glucose / Q000008:administration & dosage / Q000032:analysis*; D017127:Glycation End Products, Advanced / Q000097:blood*; D006801:Humans; D007552:Isotonic Solutions / Q000737:chemistry; D008297:Male; D009504:Neutrophils / Q000187:drug effects / Q000378:metabolism; D019999:Pharmaceutical Solutions / Q000737:chemistry*; D012462:Saline Solution, Hypertonic / Q000737:chemistry; D013242:Sterilization
D017127:Glycation End Products, Advanced; D007552:Isotonic Solutions; D019999:Pharmaceutical Solutions; D012462:Saline Solution, Hypertonic; D005947:Glucose
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