The rule regulating pH changes during crystalloid infusion

作者：Carlesso E; Maiocchi G; Tallarini F; Polli F; Valenza F; Cadringher P; Gattinoni L^*

来源：Intensive Care Medicine, 2011, 37(3): 461-468.

DOI：10.1007/s00134-010-2095-y

• Acid-base equilibrium
• Volume resuscitation
• Stewart's approach
• Balanced solution
• Crystalloids

To define the rule according to which crystalloid solutions characterized by different strong ion difference (SID) modify the acid-base variables of human plasma.
With a previously validated software, we computed the effects of diluting human plasma with crystalloid solutions ([SID] 0-60, 10 mEq/l stepwise). An equation was derived to compute the diluent [SID] required to maintain the baseline pH unchanged, at constant PCO(2) and at every dilution fraction. The results were experimentally tested using fresh frozen plasma, re-warmed at 37A degrees C, equilibrated at PCO(2) 35 and 78 mmHg, at baseline and after the infusion of crystalloid solutions with 0, 12, 24, 36, 48 mEq/l [SID].
The mathematical analysis showed that the diluent [SID] required to maintain unmodified the baseline pH equals the baseline bicarbonate concentration, [HCO (3) (-) ], assuming constant PCO(2) throughout the process. The experimental data confirmed the theoretical analysis. In fact, at the baseline [HCO (3) (-) ] of 18.3 +/- A 0.3 mmol/l (PCO(2) 35 mmHg) the pH was 7.332 +/- A 0.004 and remained 7.333 +/- A 0.003 when the diluting [SID] was 18.5 +/- A 0.0 mEq/l. At baseline [HCO (3) (-) ] of 19.5 +/- A 0.3 mmol/l (PCO(2) 78 mmHg) the pH was 7.010 +/- A 0.003 and remained 7.004 +/- A 0.003 when the diluting [SID] was 19.1 +/- A 0.1 mEq/l. At both PCO(2) values infusion with [SID] lower or greater than baseline [HCO (3) (-) ] led pH to decrease or increase, respectively.
The baseline [HCO (3) (-) ] dictates the pH response to crystalloid infusion. If a crystalloid [SID] equals baseline [HCO (3) (-) ], pH remains unchanged at constant PCO(2), whereas it increases or decreases if the [SID] is greater or lower, respectively.

• 出版日期2011-3