Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.
ADVANCED SEARCH
Log in
Top
Critical Care
Published in: Critical Care 1/2017

Open Access 01-12-2017 | Research

Comparison of fluid balance and hemodynamic and metabolic effects of sodium lactate versus sodium bicarbonate versus 0.9% NaCl in porcine endotoxic shock: a randomized, open-label, controlled study

Authors: Thibault Duburcq, Arthur Durand, Anne-Frédérique Dessein, Joseph Vamecq, Jean-Claude Vienne, Dries Dobbelaere, Karine Mention, Claire Douillard, Patrice Maboudou, Valery Gmyr, François Pattou, Mercé Jourdain, Fabienne Tamion, Julien Poissy, Daniel Mathieu, Raphaël Favory

Published in: Critical Care | Issue 1/2017

Login to get access

Abstract

Background

Sodium lactate has been shown to improve hemodynamics and avoid fluid overload. The objective of this study was to confirm a beneficial effect on fluid balance with sodium lactate infusion and to specify whether the advantage of lactate is related to a negative chloride balance, its particular metabolism, or simply its energy load.

Methods

This was an interventional, randomized, open-label, controlled experimental study. Fifteen female “large white” pigs (2 months old) were challenged with intravenous infusion of Escherichia coli endotoxin. Three groups of five animals were randomly assigned to receive different fluids: a treatment group received sodium lactate 11.2% (SL group); an isotonic control group received 0.9% NaCl (NC group); and a hypertonic control group, with the same amount of osmoles and sodium as the SL group, received sodium bicarbonate 8.4% (SB group). In order to provide the same energy load in the three groups, control groups were perfused with an equivalent energy supply. Statistical analysis was performed with non-parametric tests and the Dunn correction for multiple comparisons at p < 0.05.

Results

Fluid and chloride balance, hemodynamics, oxygenation markers, and microcirculatory parameters were measured over a 5-h period. Cumulative fluid balance was significantly lower in the SL group (550 (415–800) mL; median (interquartile range)) compared to the NC group (1100 (920–1640) mL, p = 0.01) and the SB group (935 (790–1220) mL, p = 0.03). Hemodynamics, cardiac efficiency, and microcirculation were significantly enhanced in the SL group, resulting in a significant improvement in oxygen delivery (SL group 417 (305–565) mL/min/m2 at 300 min versus the NC (207 (119–272) mL/min/m2, p = 0.01) and the SB (278, (211–315) mL/min/m2, p = 0.03) groups). Oxygenation markers (arterial oxygen partial pressure (PaO2)/inspired oxygen fraction (FiO2), mixed venous oxygen saturation (SvO2), and venoarterial carbon dioxide tension difference (Pv-aCO2) were enhanced with sodium lactate infusion. Chloride balance was equivalent in both hypertonic groups and significantly reduced compared to the NC group.

Conclusion

Sodium lactate infusion improves fluid balance and hemodynamics. The advantage of lactate does not seem to be explained by its energy load or by the induced negative chloride balance with subsequent water movements.
Appendix
Available only for authorised users
Literature
1.
Singer M, Deutschman CS, Seymour CW, Shankar-Hari M, Annane D, Bauer M, et al. The third international consensus definitions for sepsis and septic shock (Sepsis-3). JAMA. 2016;315:801–10.CrossRefPubMedPubMedCentral
2.
Fleischmann C, Scherag A, Adhikari NKJ, Hartog CS, Tsaganos T, Schlattmann P, et al. Assessment of global incidence and mortality of hospital-treated sepsis. Current estimates and limitations. Am J Respir Crit Care Med. 2016;193:259–72.CrossRefPubMed
3.
Dellinger RP, Levy MM, Rhodes A, Annane D, Gerlach H, Opal SM, et al. Surviving Sepsis Campaign: international guidelines for management of severe sepsis and septic shock, 2012. Intensive Care Med. 2013;39:165–228.CrossRefPubMed
4.
Boyd JH, Forbes J, Nakada T, Walley KR, Russell JA. Fluid resuscitation in septic shock: a positive fluid balance and elevated central venous pressure are associated with increased mortality. Crit Care Med. 2011;39:259–65.CrossRefPubMed
5.
6.
Payen D, de Pont AC, Sakr Y, Spies C, Reinhart K, Vincent JL. A positive fluid balance is associated with a worse outcome in patients with acute renal failure. Crit Care. 2008;12:R74.CrossRefPubMedPubMedCentral
7.
Sirvent J-M, Ferri C, Baró A, Murcia C, Lorencio C. Fluid balance in sepsis and septic shock as a determining factor of mortality. Am J Emerg Med. 2015;33:186–9.CrossRefPubMed
8.
de Oliveira FSV, Freitas FGR, Ferreira EM, de Castro I, Bafi AT, de Azevedo LCP, et al. Positive fluid balance as a prognostic factor for mortality and acute kidney injury in severe sepsis and septic shock. J Crit Care. 2015;30:97–101.CrossRefPubMed
9.
10.
Murphy CV, Schramm GE, Doherty JA, Reichley RM, Gajic O, Afessa B, et al. The importance of fluid management in acute lung injury secondary to septic shock. Chest. 2009;136:102–9.CrossRefPubMed
11.
van Haren FMP, Sleigh J, Boerma EC, La Pine M, Bahr M, Pickkers P, et al. Hypertonic fluid administration in patients with septic shock: a prospective randomized controlled pilot study. Shock. 2012;37:268–75.CrossRefPubMed
12.
Yunos NM, Bellomo R, Hegarty C, Story D, Ho L, Bailey M. Association between a chloride-liberal vs chloride-restrictive intravenous fluid administration strategy and kidney injury in critically ill adults. JAMA. 2012;308:1566–72.CrossRefPubMed
13.
Chioléro R, Schneiter P, Cayeux C, Temler E, Jéquier E, Schindler C, et al. Metabolic and respiratory effects of sodium lactate during short i.v. nutrition in critically ill patients. J Parenter Enteral Nutr. 1996;20:257–63.CrossRef
14.
Chioléro RL, Revelly JP, Leverve X, Gersbach P, Cayeux MC, Berger MM, et al. Effects of cardiogenic shock on lactate and glucose metabolism after heart surgery. Crit Care Med. 2000;28:3784–91.CrossRefPubMed
15.
Leverve XM, Boon C, Hakim T, Anwar M, Siregar E, Mustafa I. Half-molar sodium-lactate solution has a beneficial effect in patients after coronary artery bypass grafting. Intensive Care Med. 2008;34:1796–803.CrossRefPubMed
16.
Ichai C, Armando G, Orban J, Berthier F, Rami L, Samat-long C, et al. Sodium lactate versus mannitol in the treatment of intracranial hypertensive episodes in severe traumatic brain-injured patients. Intensive Care Med. 2009;35:471–9.CrossRefPubMed
17.
Somasetia DH, Setiati TE, Sjahrodji AM, Idjradinata PS, Setiabudi D, Roth H, et al. Early resuscitation of Dengue shock syndrome in children with hyperosmolar sodium lactate: a randomized single blind clinical trial of efficacy and safety. Crit Care. 2014;18:466.CrossRefPubMedPubMedCentral
18.
Nalos M, Leverve XM, Huang SJ, Weisbrodt L, Parkin R, Seppelt IM, et al. Half-molar sodium lactate infusion improves cardiac performance in acute heart failure: a pilot randomized controlled clinical trial. Crit Care. 2014;18:R48.CrossRefPubMedPubMedCentral
19.
Duburcq T, Favory R, Mathieu D, Hubert T, Mangalaboyi J, Gmyr V, et al. Hypertonic sodium lactate improves fluid balance and hemodynamics in porcine endotoxic shock. Crit Care. 2014;18:467.CrossRefPubMedPubMedCentral
20.
21.
Creteur J, Carollo T, Soldati G, Buchele G, De Backer D, Vincent J-L. The prognostic value of muscle StO2 in septic patients. Intensive Care Med. 2007;33:1549–56.CrossRefPubMed
22.
Arnold RC, Parrillo JE, Phillip Dellinger R, Chansky ME, Shapiro NI, Lundy DJ, et al. Point-of-care assessment of microvascular blood flow in critically ill patients. Intensive Care Med. 2009;35:1761–6.CrossRefPubMed
23.
Breslow MJ, Miller CF, Parker SD, Walman AT, Traystman RJ. Effect of vasopressors on organ blood flow during endotoxin shock in pigs. Am J Physiol. 1987;252:H291–300.PubMed
24.
Duburcq T, Hubert T, Saint-Léger P, Mangalaboyi J, Favory R, Gmyr V, et al. Impact of endotoxin challenge in obese pigs. Shock. 2014;41:546–53.CrossRefPubMed
25.
Ichai C, Payen J-F, Orban J-C, Quintard H, Roth H, Legrand R, et al. Half-molar sodium lactate infusion to prevent intracranial hypertensive episodes in severe traumatic brain injured patients: a randomized controlled trial. Intensive Care Med. 2013;39:1413–22.CrossRefPubMed
26.
Jayakumar AR, Panickar KS, Curtis KM, Tong XY, Moriyama M, Norenberg MD. Na-K-Cl cotransporter-1 in the mechanism of cell swelling in cultured astrocytes after fluid percussion injury. J Neurochem. 2011;117:437–48.CrossRefPubMed
27.
Jayakumar AR, Norenberg MD. The Na-K-Cl co-transporter in astrocyte swelling. Metab Brain Dis. 2010;25:31–8.CrossRefPubMed
28.
29.
van Hall G. Lactate kinetics in human tissues at rest and during exercise. Acta Physiol. 2010;199:499–508.CrossRef
30.
Kline JA, Thornton LR, Lopaschuk GD, Barbee RW, Watts JA. Lactate improves cardiac efficiency after hemorrhagic shock. Shock. 2000;14:215–21.CrossRefPubMed
31.
Barbee RW, Kline JA, Watts JA. Depletion of lactate by dichloroacetate reduces cardiac efficiency after hemorrhagic shock. Shock. 2000;14:208–14.CrossRefPubMed
32.
Levy B, Mansart A, Montemont C, Gibot S, Mallie J-P, Regnault V, et al. Myocardial lactate deprivation is associated with decreased cardiovascular performance, decreased myocardial energetics, and early death in endotoxic shock. Intensive Care Med. 2007;33:495–502.CrossRefPubMed
33.
Jourdain M, Tournoys A, Leroy X, Mangalaboyi J, Fourrier F, Goudemand J, et al. Effects of N omega-nitro-L-arginine methyl ester on the endotoxin-induced disseminated intravascular coagulation in porcine septic shock. Crit Care Med. 1997;25:452–9.CrossRefPubMed
34.
Hoffmann EK, Lambert IH, Pedersen SF. Physiology of cell volume regulation in vertebrates. Physiol Rev. 2009;89:193–277.CrossRefPubMed
35.
Hoque R, Farooq A, Ghani A, Gorelick F, Mehal WZ. Lactate reduces liver and pancreatic injury in Toll-like receptor- and inflammasome-mediated inflammation via GPR81-mediated suppression of innate immunity. Gastroenterology. 2014;146:1763–74.CrossRefPubMedPubMedCentral
36.
Su F, Xie K, He X, Cortés DO, Hosokawa K, Post EH, et al. The harmful effects of hypertonic sodium lactate administration in hyperdynamic septic shock. Shock. 2016;46:663–71.CrossRefPubMed
Metadata
Title
Comparison of fluid balance and hemodynamic and metabolic effects of sodium lactate versus sodium bicarbonate versus 0.9% NaCl in porcine endotoxic shock: a randomized, open-label, controlled study
Authors
Thibault Duburcq
Arthur Durand
Anne-Frédérique Dessein
Joseph Vamecq
Jean-Claude Vienne
Dries Dobbelaere
Karine Mention
Claire Douillard
Patrice Maboudou
Valery Gmyr
François Pattou
Mercé Jourdain
Fabienne Tamion
Julien Poissy
Daniel Mathieu
Raphaël Favory
Publication date
01-12-2017
Publisher
BioMed Central
Published in
Critical Care / Issue 1/2017
Electronic ISSN: 1364-8535
DOI
https://doi.org/10.1186/s13054-017-1694-1

Other articles of this Issue 1/2017

Critical Care 1/2017 Go to the issue

Letter

Diaphragm electrical activity monitoring as a breakpoint in the management of a tetraplegic child

Letter

The importance of diastolic dysfunction in the development of weaning-induced pulmonary oedema

Research

What is the impact of the fluid challenge technique on diagnosis of fluid responsiveness? A systematic review and meta-analysis

Research

Simplified prognostic model for critically ill patients in resource limited settings in South Asia

Research

Timing of renal replacement therapy and long-term risk of chronic kidney disease and death in intensive care patients with acute kidney injury

Letter

Effect of extended visiting hours on physician distractions in the ICU: a before-and-after study