[Bicarbonate instead of lactate buffered substitution solution for continuous hemofiltration in intensive care].

C J Olbricht, D Huxmann-Nägeli, H Bischoff
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Abstract

The substitution fluids applied in continuous haemofiltration contain 40 mmol/l of lactate. This is unphysiological, since administration of large amounts of lactate lowers the phosphorylation potential and increases catabolism. With bicarbonate-buffered fluid three problems may arise: 1. Precipitation of calcium carbonate and magnesium carbonate; 2. pH is usually 8.4; 3. evaporation of CO2 increases pH. To solve these problems we applied a two-component system consisting of a glass bottle with 160 ml sodium bicarbonate 8.4% and a bag with 4.5 l of acidic solution. Prior to use, the bicarbonate was infused into the bag. The values of Ca++, Mg++, bicarbonate, and pH in this final substitution solution were constant during a 24 hr period after mixing. Precipitation of Ca++ and Mg++ carbonate was prevented by 3 mmol/l of lactic acid in the solution. The pH was 7.37. Evaporation of CO2 was prevented by bags made of special plastic sheeting. The solution was then applied in 7 intensive-care patients suffering from acute renal failure treated by continuous arteriovenous haemofiltration. No side effects of the solution were observed during six days of treatment. The values of Ca++, bicarbonate, pH, and pCO2 remained constant under clinical routine conditions. Hence, bicarbonate-buffered substitution solution is recommended for continuous haemofiltration. Continuous haemofiltration is now also available for patients with impaired liver function and increased lactate levels.

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[碳酸氢盐代替乳酸缓冲替代溶液用于重症监护的持续血液过滤]。
用于连续血液过滤的替代液含有40 mmol/l的乳酸。这是非生理性的,因为大量的乳酸降低了磷酸化电位,增加了分解代谢。碳酸氢盐缓冲液可能出现三个问题:碳酸钙和碳酸镁的沉淀;2. pH值通常为8.4;3.为了解决这些问题,我们采用了一个双组分系统,由一个装有160毫升8.4%碳酸氢钠的玻璃瓶和一个装有4.5升酸性溶液的袋子组成。在使用之前,将碳酸氢盐注入袋子中。在混合后的24小时内,最终替代溶液中的Ca++、Mg++、碳酸氢盐和pH值保持不变。溶液中加入3 mmol/l的乳酸可阻止碳酸钙和碳酸镁的析出。pH值为7.37。用特殊塑料布制成的袋子防止了二氧化碳的蒸发。将该溶液应用于7例经动静脉持续血液滤过治疗的急性肾功能衰竭重症监护患者。在6天的治疗期间,未观察到该溶液的副作用。在临床常规条件下,Ca++、碳酸氢盐、pH和pCO2值保持不变。因此,建议使用碳酸氢盐缓冲替代溶液进行连续血液过滤。持续血液滤过现在也可用于肝功能受损和乳酸水平升高的患者。
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