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Intensive Care Medicine
Published in: Intensive Care Medicine 7/2003

01-07-2003 | Original

The impact of lactate-buffered high-volume hemofiltration on acid-base balance

Authors: Louise Cole, Rinaldo Bellomo, Ian Baldwin, Matthew Hayhoe, Claudio Ronco

Published in: Intensive Care Medicine | Issue 7/2003

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Abstract

Objective

To evaluate the effect of high-volume hemofiltration (HVHF) with lactate-buffered replacement fluids on acid-base balance.

Design

Randomized crossover study.

Setting

Intensive Care Unit of Tertiary Medical Center

Participants

Ten patients with septic shock and acute renal failure.

Interventions

Random allocation to 8 h of isovolemic high-volume hemofiltration (ultrafiltration rate: 6 l/h) or 8 h of isovolemic continuous venovenous hemofiltration (ultrafiltration rate: 1 l/h) with lactate-buffered replacement fluid with subsequent crossover.

Measurements and results

We measured blood gases, electrolytes, albumin, and lactate concentrations and completed quantitative biophysical analysis of acid-base balance changes. Before high-volume hemofiltration, patients had a slight metabolic alkalosis [pH: 7.42; base excess (BE) 2.4 mEq/l] despite hyperlactatemia (lactate: 2.51 mmol/l). After 2 h of high-volume hemofiltration, the mean lactate concentration increased to 7.30 mmol/l (p=0.0001). However, a decrease in chloride, strong ion difference effective, and strong ion gap (SIG) compensated for the effect of iatrogenic hyperlactatemia so that the pH only decreased to 7.39 (p=0.05) and the BE to −0.15 (p=0.001). After 6 h, despite persistent hyperlactatemia (7 mmol/l), the pH had returned to 7.42 and the BE to 2.45 mEq/l. These changes remained essentially stable at 8 h. Similar but less intense changes occurred during continuous venovenous hemofiltration.

Conclusions

HVHF with lactate-buffered replacement fluids induces iatrogenic hyperlactatemia. However, such hyperlactatemia only has a mild and transient acidifying effect. A decrease in chloride and strong ion difference effective and the removal of unmeasured anions all rapidly compensate for this effect.
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Metadata
Title
The impact of lactate-buffered high-volume hemofiltration on acid-base balance
Authors
Louise Cole
Rinaldo Bellomo
Ian Baldwin
Matthew Hayhoe
Claudio Ronco
Publication date
01-07-2003
Publisher
Springer-Verlag
Published in
Intensive Care Medicine / Issue 7/2003
Print ISSN: 0342-4642
Electronic ISSN: 1432-1238
DOI
https://doi.org/10.1007/s00134-003-1812-1

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