title: The unrecognized effects of the volume and composition of the resuscitation fluid used during the administration of blood products.
abstract: BACKGROUND
  Recent publications have reported the severe adverse events associated with blood products but have not considered the effect of the volume and composition of the resuscitative fluids infused with the blood products.
  
  
  METHODS
  Injury leads to cellular reaction characterized by insulin resistance during which glucose cannot enter muscle and fat cells. In all cells, mitochondrial pyruvate dehydrogenase activity is decreased during insulin deficiency leaving cells deficient in substrates needed to power the Krebs cycle and make ATP.
  
  
  RESULTS
  d-β-Hydroxybutyrate, a normal ketone body metabolite, enters cells on the monocarboxylate transport mimicking the action of insulin and bypassing the enzymatic block at PDH. Metabolism of ketone bodies increases efficiency of mitochondrial energy production and cellular ATP level.
  
  
  CONCLUSIONS
  Infusion of 250 ml of 600 mM Na d-β-hydroxybutyrate solution, with the same osmotic strength as the hypertonic NaCl solution currently being used, would correct insulin resistance, provide energy substrates for cells to produce ATP, correct the tendency of injured tissue to swell due to decreased energy of ionic gradients and correct acidosis observed in hemorrhage.
authors.affiliation: Naval Blood Research Lab Inc., 195 Bournehurst Drive, Plymouth, MA 02360, United States. navblood@nbrl.org
authors.forename: C
authors.initials: C
authors.lastname: Robert Valeri
authors.forename: Richard L
authors.initials: RL
authors.lastname: Veech
mesh_terms: D000255:Adenosine Triphosphate / Q000378:metabolism; D017667:Adipocytes / Q000378:metabolism; D016913:Blood Component Transfusion; D002952:Citric Acid Cycle / Q000187:drug effects; D005947:Glucose / Q000378:metabolism; D006801:Humans; D007328:Insulin / Q000378:metabolism; D007333:Insulin Resistance; D008928:Mitochondria / Q000378:metabolism; D018482:Muscle, Skeletal / Q000378:metabolism; D011768:Pyruvate Dehydrogenase Complex / Q000378:metabolism; D012151:Resuscitation / Q000379:methods*; D012978:Sodium Oxybate / Q000627:therapeutic use*
chemical_list: D007328:Insulin; D011768:Pyruvate Dehydrogenase Complex; D012978:Sodium Oxybate; D000255:Adenosine Triphosphate; D005947:Glucose