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Balanced Electrolyte Solution Reduces Acidosis as Compared to Normal Saline in the Resuscitation of Perioperative Burn Patients
Steven C. Walker, M.D., Ph.D.; Lance R. Hoover, M.D.; John M. Shepherd, M.D.; Leopoldo Cancio, M.D.; Cleon Goodwin, M.D.
Anesthesiology, Washington University Medical School, St. Louis, Missouri, United States
Background: A perioperative acidosis among burn patients is usually attributed to ongoing blood loss, hypovolemia and tissue hypoperfusion. Normal saline, when given in large volumes, can cause hyperchloremic non-anion gap metabolic acidosis, and in this population could. invite inappropriate therapy. In contrast to sodium chloride solutions, balanced electrolyte solutions (Plasmalyte, Normosol, Isolyte) do not contain excess chloride ion and can be given with blood in the operating theater. This is a retrospective case control study of changes in arterial blood bicarbonate concentration and buffering capacity in burn patients following large volume resuscitations with either normal saline or balanced electrolyte solution during excision and grafting.

Methods: Following Institutional Review Board Approval, patients with a total body surface area burned of 20% or greater, estimated blood loss between 500 and 1500 cc, and cystalloid (no colloid) resuscitation of greater than 70% of total estimated blood volume, were included in the study. A total of 24 patients undergoing excision and grafting were selected with nine patients in the balanced electrolyte solution group and fifteen in the normal saline group. Arterial blood gas samples were taken as clinically indicated at frequent intervals during the surgery. Changes over the course of surgery in the base deficit and bicarbonate ion concentration were compared within and between the two groups. Groups were matched on burn size, estimated blood loss, volume of resuscitation and volume of blood administered

Results: Perioperative changes in base deficit and bicarbonate were statistically significant in both groups (p<0.05). The balanced electrolyte solution group preserved bicarbonate ion with a mean change of +0.08 following resuscitation. Base deficit improved in the balanced electrolyte solution group with a final mean change of +0.28. Bicarbonate and total buffering capacity in the normal saline group fell significantly as compared to the balanced electrolyte solution group (p<0.002).

Conclusions: This study supports the chloride ion effect for normal saline in large volume resuscitations and suggests an inherent buffering capacity in balanced electrolyte solutions. The reduced chloride ion concentration and the inherent buffering capacity in balanced electrolyte solution could present a significant advantage over normal saline in large volume perioperative fluid resuscitations among burn patients.

Anesthesiology 2001; 95:A375