The effect of acetate Ringer\u2019s solution versus lactate Ringer\u2019s solution on acid base physiology in infants with biliary atresia

Xiang Liu,Lei Shi,Hongyan Cao,Qi Zhang,Xiaona Tan,Li Qiao,Jing Shi

doi:10.1186/s12887-021-03074-4

Abstract

BackgroundThe choice of the perioperative crystalloid is a key component of the fluid management and must take into account the liver function and the appearing metabolic disorders to avoid increase the liver extra metabolism. The aim of this study is to analyze the effect of acetate Ringer’s solution or lactate Ringer’s solution in biliary atresia patients.MethodsWe included 68 infant patients aged between 21 ~ 65 d, ASA physical status II or III, who underwent elective Kasai hepatoportoenterostomy, received either AR and LR for intravenous fluid resuscitation according to their group allocation. Lactate concentration, serum electrolytes and pH were noteded before skin incision (T1), end of surgery (T2) and postoperative 12 h. We also recorded the time of operation, stay of hospital, loss of blood and urinary, total volume of infusion of crystalloid.ResultsLactate level was significantly higher in Group LR than in Group AR patients at T2 (0.76 ± 0.13 versus 0.57 ± 0.22, P = 0.03). Compared with T3, sodium and chlorine were significantly higher in two groups at T2 (145.2 ± 3.1 versus 143.4 ± 3.4 and 104.6 ± 3.7 versus 105.2 ± 2.1). No significant differences were noted in potassium, HCO3− and calcium. There was no statistically significant difference in pH. No glycopenia was recorded in two groups. No significant difference was noted in administration of vasoactive drug (0.7% versus 1%).ConclusionsResuscitation with AR and LR was associated with similar clinical improvement in infants with biliary atresia. Use of AR reduced the level of lactate comparison with LR.

Highlights

The aim of perioperative fluid therapy is to provide adequate intravascular volume to ensure tissue perfusion and cellular oxygenation that is the physiologic goal independent of the type of surgery
There were no significant differences between the groups in coagulation function (PT, Prothrombin time; APTT, Activated partial thromboplastin time) and hepatic function (ALT, Alanine transaminase; AST, Aspartate aminotransferase) (Table 2)
Lactate and serum electrolytes levels were compared between the two groups at different time points

Summary

Introduction

The aim of perioperative fluid therapy is to provide adequate intravascular volume to ensure tissue perfusion and cellular oxygenation that is the physiologic goal independent of the type of surgery. Acetate is more rapidly metabolised with less oxygen demand and extra hepatic [6]. It could reduce the liver metabolic burden, especially in infants who already had liver function damage. We hypothesized that liver relatively had a better functional reserve to metabolize the extra lactate after acetate Ringer infusion than that after lactate Ringer’s solution. The primary main objective of this randomized controlled trial was to compare the effect of acetate Ringer’s solution or lactate Ringer’s solution on lactate and HCO3− level in biliary atresia patients. The aim of this study is to analyze the effect of acetate Ringer’s solution or lactate Ringer’s solution in biliary atresia patients

Objectives

Methods

Results