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Title: Electrolyte mass balance during CVVH: lactate vs. bicarbonate-buffered replacement fluids.
Austin Authors: Tan, Han Khim;Uchino, Shigehiko;Bellomo, Rinaldo 
Affiliation: Department of Intensive Care and Surgery, Austin Hospital, Melbourne, Australia
Issue Date: 1-Mar-2004
Publication information: Renal Failure; 26(2): 149-53
Abstract: To compare the effect of lactate vs. bicarbonate-buffered replacement fluids on electrolyte mass balance during isovolemic continuous veno-venous hemofiltration (CVVH).Randomized controlled study with double cross over.Intensive care unit of a tertiary university hospital.Eight patients with acute renal failure (ARF).Isovolemic CVVH (2L/hr of replacement fluid) was performed in random order with either bicarbonate or lactate-buffered replacement fluid delivered pre-filter.Sodium, potassium, chloride, magnesium, and phosphate, were measured in each sample. There was a mass gain of sodium, which was similar under both conditions (bicarbonate: 23.3+/-4.9 mmol/hr, lactate: 22.7+/-3.5 mmol/hr). Mass chloride gains occurred with bicarbonate-buffered replacement fluid only (12.8+/-5.3 mmol/hr), while there was an overall net loss of chloride with lactate fluids (-2.5+/-5.2 mmol/hr), resulting in a significant difference in chloride mass balance (p<0.0001). Magnesium mass balance was negative with bicarbonate buffer only (-0.6+/-0.2 mmol/hr) and also differed significantly from that obtained with lactate fluids (-0.1+/-0.2 mmol/hr, p<0.0001). Phosphate losses (bicarbonate: -1.7+/-0.7 mmol/hr, lactate: -1.7+/-0.5 mmol/hr) were equivalent with both buffers. Potassium mass balance was neutral.Mass balance during isovolemic CVVH is significantly affected by the type of replacement fluid administered prefilter. Isovolemic CVVH is not isonatremic and the use of bicarbonate-buffered fluid results in a significant accumulation of chloride and a loss of magnesium.
Gov't Doc #: 15287198
Journal: Renal failure
Type: Journal Article
Subjects: Acute Kidney Injury.diagnosis.mortality.therapy
Bicarbonates.therapeutic use
Cross-Over Studies
Emergency Service, Hospital
Follow-Up Studies
Hemodialysis Solutions
Middle Aged
Risk Assessment
Sodium Lactate.therapeutic use
Statistics, Nonparametric
Survival Rate
Treatment Outcome
Water-Electrolyte Balance.physiology
Appears in Collections:Journal articles

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