title: The role of bicarbonate precursors in balanced fluids during haemorrhagic shock with and without compromised liver function.
abstract: BACKGROUND
  Lactate, acetate, and gluconate are anions used in balanced resuscitation fluids, of which lactate and acetate are considered bicarbonate precursors. This study investigated the role of the liver in the ability of balanced and unbalanced solutions to correct acid-base alterations and renal haemodynamics and microvascular oxygenation in a rat model of resuscitated haemorrhagic shock.
  
  
  METHODS
  Ringer's lactate, Ringer's acetate, PlasmaLyte, or normal saline were administered following haemorrhagic shock in the presence or absence of a 70% partial liver resection. Renal haemodynamics and microvascular oxygenation (by oxygen-dependent quenching of phosphorescence) were measured as well as concentrations of lactate, gluconate, and acetate in plasma and urine. Kidney wet and dry weight was also assessed.
  
  
  RESULTS
  Partial liver resection resulted in increased liver enzymes compared with control and shock groups (P < 0.01). Haemorrhagic shock decreased systemic and renal perfusion and reduced microvascular kidney oxygenation with lactic acidosis (P < 0.01). Resuscitation with balanced fluids did not fully restore renal oxygenation (P < 0.01). Ringer's acetate and PlasmaLyte increased bicarbonate content and restored pH better than Ringer's lactate or saline after partial liver resection (P < 0.01). Liver resection caused an increase in plasma gluconate after PlasmaLyte resuscitation (P < 0.05).
  
  
  CONCLUSIONS
  Acetate-buffered balanced fluids show superior buffering effects compared with Ringer's lactate or saline. Gluconate is partially metabolized by the liver, although it does not contribute to acid-base control because of its excretion in urine. Acetate is metabolized regardless of liver function and may be the most efficient bicarbonate precursor. Lactate infusion tends to overwhelm the metabolism capacity of the residual liver.
authors.affiliation: Department of Translational Physiology, Academic Medical Centre, Amsterdam, The Netherlands.
authors.forename: B
authors.initials: B
authors.lastname: Ergin
authors.affiliation: Department of Biology, Science Faculty, University of Istanbul, Istanbul, Turkey.
authors.forename: A
authors.initials: A
authors.lastname: Kapucu
authors.affiliation: Department of Translational Physiology, Academic Medical Centre, Amsterdam, The Netherlands.|University of Lorraine, Vandoeuvre-les-Nancy, INSERM U1116, Nancy, France.
authors.forename: P
authors.initials: P
authors.lastname: Guerci
authors.affiliation: Department of Translational Physiology, Academic Medical Centre, Amsterdam, The Netherlands c.ince@amc.uva.nl.
authors.forename: C
authors.initials: C
authors.lastname: Ince
mesh_terms: D000085:Acetates / Q000378:metabolism; D000136:Acid-Base Equilibrium; D000818:Animals; D001639:Bicarbonates / Q000378:metabolism*; D005440:Fluid Therapy; D007668:Kidney / Q000378:metabolism; D019344:Lactic Acid / Q000378:metabolism; D008099:Liver / Q000502:physiology*; D008297:Male; D051381:Rats; D017207:Rats, Sprague-Dawley; D012151:Resuscitation; D012771:Shock, Hemorrhagic / Q000378:metabolism / Q000628:therapy*
chemical_list: D000085:Acetates; D001639:Bicarbonates; D019344:Lactic Acid
keywords: PlasmaLyte; buffered solution; gluconate; haemorrhagic shock; microcirculation