title: Plasma acetate, gluconate and interleukin-6 profiles during and after cardiopulmonary bypass: a comparison of Plasma-Lyte 148 with a bicarbonate-balanced solution.
abstract: BACKGROUND
  As even small concentrations of acetate in the plasma result in pro-inflammatory and cardiotoxic effects, it has been removed from renal replacement fluids. However, Plasma-Lyte 148 (Plasma-Lyte), an electrolyte replacement solution containing acetate plus gluconate is a common circuit prime for cardio-pulmonary bypass (CPB). No published data exist on the peak plasma acetate and gluconate concentrations resulting from the use of Plasma-Lyte 148 during CPB.
  
  
  METHODS
  Thirty adult patients were systematically allocated 1:1 to CPB prime with either bicarbonate-balanced fluid (24 mmol/L bicarbonate) or Plasma-Lyte 148. Arterial blood acetate, gluconate and interleukin-6 (IL-6) levels were measured immediately before CPB (T1), three minutes after CPB commencement (T2), immediately before CPB separation (T3), and four hours post separation (T4).
  
  
  RESULTS
  Acetate concentrations (normal 0.04 to 0.07 mmol/L) became markedly elevated at T2, where the Plasma-Lyte group (median 3.69, range (2.46 to 8.55)) exceeded the bicarbonate group (0.16 (0.02 to 3.49), P < 0.0005). At T3, levels had declined but the differential pattern remained apparent (Plasma-Lyte 0.35 (0.00 to 1.84) versus bicarbonate 0.17 (0.00 to 0.81)). Normal circulating acetate concentrations were not restored until T4. Similar gluconate concentration profiles and inter-group differences were seen, with a slower T3 decay. IL-6 increased across CPB, peaking at T4, with no clear difference between groups.
  
  
  CONCLUSIONS
  Use of acetate containing prime solutions result in supraphysiological plasma concentrations of acetate. The use of acetate-free prime fluid in CPB significantly reduced but did not eliminate large acetate surges in cardiac surgical patients. Complete elimination of acetate surges would require the use of acetate free bolus fluids and cardioplegia solutions.
  
  
  BACKGROUND
  Australia and New Zealand Clinical Trials Register (ANZCTR): ACTRN12610000267055.
authors.affiliation: DDepartment of Anaesthesia, Princess Alexandra Hospital, University of Queensland, Ipswich Road, Woolloongabba, QLD 4102, Australia.
authors.forename: Paul G
authors.initials: PG
authors.lastname: Davies
authors.forename: Balasubramanian
authors.initials: B
authors.lastname: Venkatesh
authors.forename: Thomas J
authors.initials: TJ
authors.lastname: Morgan
authors.forename: Jeffrey J
authors.initials: JJ
authors.lastname: Presneill
authors.forename: Peter S
authors.initials: PS
authors.lastname: Kruger
authors.forename: Bronwyn J
authors.initials: BJ
authors.lastname: Thomas
authors.forename: Michael S
authors.initials: MS
authors.lastname: Roberts
authors.forename: Julie
authors.initials: J
authors.lastname: Mundy
mesh_terms: D000085:Acetates / Q000097:blood*; D000368:Aged; D001639:Bicarbonates / Q000627:therapeutic use*; D002315:Cardiopulmonary Bypass / Q000379:methods*; D005260:Female; D005942:Gluconates / Q000097:blood* / Q000627:therapeutic use; D006801:Humans; D015850:Interleukin-6 / Q000097:blood*; D007432:Intraoperative Period; D007552:Isotonic Solutions; D015636:Magnesium Chloride / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D011184:Postoperative Period; D011189:Potassium Chloride / Q000627:therapeutic use; D019346:Sodium Acetate / Q000627:therapeutic use; D012965:Sodium Chloride / Q000627:therapeutic use; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000085:Acetates; D001639:Bicarbonates; D005942:Gluconates; D015850:Interleukin-6; D007552:Isotonic Solutions; C012499:Plasma-lyte 148; D015636:Magnesium Chloride; D012965:Sodium Chloride; D019346:Sodium Acetate; D011189:Potassium Chloride