Safety of glucose-containing solutions during accidental hyperinfusion in piglets.
BACKGROUND
Errors in fluid management can lead to significant morbidity in children. We conducted an experimental animal study to determine the margin of safety in accidental hyperinfusion of different glucose and electrolyte containing solutions.


METHODS
Fifteen piglets [bodyweight 12.1 (sd 2.0) kg] were randomly assigned to receive either 100 ml kg⁻¹ of balanced electrolyte solution with glucose 1% (BS-G1), hypotonic electrolyte solution with glucose 5% (HE-G5), or glucose 40% solution (G40) over 1 h. Blood electrolytes, glucose, and osmolality and intracranial pressure (ICP) were measured before, during, and after fluid administration.


RESULTS
Hyperinfusion of BS-G1 led to moderate hyperglycaemia [baseline 3.4 (sd 1.3) mmol litre⁻¹, study end 12.6 (1.8) mmol litre⁻¹], but no other relevant pathophysiological alterations. Hyperinfusion of HE-G5 produced marked hyperglycaemia [baseline 3.9 (1.2) mmol litre⁻¹, study end 48.6 (4.3) mmol litre⁻¹, P < 0.05] and hyponatraemia [baseline 136.4 (1.3) mmol litre(-1), study end 119.6 (2.1) mmol litre⁻¹, P < 0.05], whereas osmolality remained stable during the course of the study. Hyperinfusion of G40 induced acute hyperglycaemic/hyperosmolar decompensation with an extreme decrease in serum electrolytes [e.g. sodium baseline 138 (1.1) mmol litre⁻¹, 30 min 87.8 (6.4) mmol litre⁻¹, P < 0.01], leading to cardiac arrest after infusion of 50-75 ml kg⁻¹. ICP remained within a physiological range in all groups.


CONCLUSIONS
In an animal model of accidental hyperinfusion, BS-G1 showed the widest margin of safety and can therefore be expected to enhance patient safety in perioperative fluid management in children; HE-G5 proved significantly less safe; and G40 was found to be outright hazardous.
Witt
L
L
Department of Anaesthesiology, Hannover Medical School, Hannover, Germany. witt.lars-henrik@mh-hannover.de
Osthaus
W A
WA
Lücke
T
T
Jüttner
B
B
Teich
N
N
Jänisch
S
S
Debertin
A S
AS
Sümpelmann
R
R
D000136:Acid-Base Equilibrium; D000818:Animals; D001786:Blood Glucose / Q000378:metabolism; D005260:Female; D005440:Fluid Therapy / Q000009:adverse effects / Q000379:methods; D005947:Glucose / Q000008:administration & dosage / Q000633:toxicity*; D005950:Glucose Solution, Hypertonic / Q000633:toxicity; D006943:Hyperglycemia / Q000209:etiology*; D007262:Infusions, Intravenous; D009994:Osmolar Concentration; D015532:Rehydration Solutions / Q000008:administration & dosage / Q000633:toxicity*; D034421:Sus scrofa
D001786:Blood Glucose; D005950:Glucose Solution, Hypertonic; D015532:Rehydration Solutions; D005947:Glucose