A randomized clinical trial comparing the effect of rapidly infused crystalloids on acid-base status in dehydrated patients in the emergency department.
OBJECTIVE
To compare the effect of normal saline (NS), lactated Ringer's, and Plasmalyte on the acid-base status of dehydrated patients in the emergency department (ED).


METHODS
We conducted a prospective, double-blind, randomized trial of consecutive adult patients who presented to the emergency department with moderate-severe dehydration. Patients were randomly allocated to blindly receive normal saline (NS), lactated Ringer's or Plasmalyte at 20 ml/kg/h for 2 hours. Outcome measures of the study were pH and changes in electrolytes, including serum potassium, sodium, chloride and bicarbonate levels at 0, 60, and 120 minutes in venous blood gas samples.


RESULTS
Ninety patients participated in the study and were randomized to NS (30 patients), lactated Ringer's (30 patients) and Plasmalyte (30 patients) groups. Mean age was 48±20 years and 50% (n=45) of the patients were female. All pH values were in the physiological range (7.35-7.45) throughout the study period. In the NS group there was a significant tendency to lower pH values, with pH values of 7.40, 7.37, and 7.36 at 0, 1, and 2 hours respectively. Average bicarbonate levels fell in the NS group (23.1, 22.2, and 21.5 mM/L) and increased in the Plasmalyte group (23.4, 23.9, and 24.4 mM/L) at 0, 1, and 2 hours, respectively. There were no significant changes in potassium, sodium, or chloride levels.


CONCLUSIONS
NS, lactated Ringer's, and Plasmalyte have no significant effect on acid-base status and all can be used safely to treat dehydrated patients in the emergency department. However, NS can effect acidosis which might be significant in patients who have underlying metabolic disturbances; thus, its use should be weighed before fluid administration in the ED.
Department of Emergency Medicine, Gulhane Military Medical Academy, GATA Acil Tip Anabilim Dali, Etlik, Ankara, Turkey. hakan_has@yahoo.com
Hakan
H
Hasman
Orhan
O
Cinar
Ahmet
A
Uzun
Erdem
E
Cevik
Loni
L
Jay
Bilgin
B
Comert
D000328:Adult; D000368:Aged; D001639:Bicarbonates / Q000097:blood; D002712:Chlorides / Q000097:blood; D000077324:Crystalloid Solutions; D003681:Dehydration / Q000097:blood / Q000188:drug therapy*; D004311:Double-Blind Method; D004573:Electrolytes / Q000008:administration & dosage; D004638:Emergency Treatment; D005260:Female; D006801:Humans; D006863:Hydrogen-Ion Concentration; D007552:Isotonic Solutions / Q000008:administration & dosage*; D008297:Male; D008875:Middle Aged; D011188:Potassium / Q000097:blood; D000077325:Ringer's Lactate; D012964:Sodium / Q000097:blood; D012965:Sodium Chloride / Q000008:administration & dosage
D001639:Bicarbonates; D002712:Chlorides; D000077324:Crystalloid Solutions; D004573:Electrolytes; D007552:Isotonic Solutions; D000077325:Ringer's Lactate; D012965:Sodium Chloride; C048013:Plasmalyte A; D012964:Sodium; D011188:Potassium