Balanced Electrolyte Solution Research Articles

Effects of Local Vasodilators and the Autonomic Nervous System on Microcirculation and Mitochondrial Function in Septic Rats.

Systemic vasodilating agents like nitroglycerin (NG) or iloprost (Ilo) show beneficial effects on intestinal microcirculation during sepsis, which could be attenuated by activation of the sympathetic nervous system or systemic side effects of vasodilating agents. This exploratory study aimed to investigate the effects of topically administered vasodilators and the parasympathetic drug carbachol on colonic microcirculatory oxygenation (µHbO2), blood flow (µFlow) and mitochondrial respiration. A total of 120 male Wistar rats were randomly assigned to twelve groups and underwent either colon ascendens stent peritonitis (CASP) or sham surgery. After 24 h, animals received the following therapeutic regimes: (1) balanced full electrolyte solution, (2) carbachol, (3) NG, (4) Ilo, (5) NG + carbachol, and (6) Ilo + carbachol. Mitochondrial respiration was measured in colon homogenates by respirometry. In sham animals, NG (-13.1%*) and Ilo (-10.5%*) led to a decrease in µHbO2. Additional application of carbachol abolished this effect (NG + carbachol: -4.0%, non-significant; Ilo + carbachol: -1.4%, non-significant). In sepsis, carbachol reduced µHbO2 when applied alone (-10.5%*) or in combination with NG (-17.6%*). Thus, the direction and degree of this effect depend on the initial pathophysiologic condition.

Selective red blood cell depletion by apheresis in sheep causes severe normovolemic anemia

Background: The setting of normovolemic anemia is required for a variety of research applications, such as testing of novel medication for anemia treatment. Unfortunately, large animal models using full blood draw and replenishment with balanced electrolyte solution (BES) lead to bleeding complications, as coagulation factors and platelets are also drawn. We therefore aimed to establish a model of selective red blood cell (RBC) depletion to the main endpoint of hemoglobin (Hgb) levels of 4–6 g dL−1 using apheresis in sheep. Methods: In vitro experiments were performed first to establish the apheresis protocol. In vivo, anesthetized ewes underwent a sham protocol without apheresis (n = 5) or apheresis (n = 4). Both groups were observed for the following six hours at a defined starting point (BE0) to compare Hgb, hematocrit (Hct), coagulation and clinical parameters. For statistical analysis, unpaired t-test with Welch`s correction was used. Results: Hgb levels were effectively decreased by 51 % to mean Hgb of 4.4 g dL−1 in the apheresis group compared to 9.1 g dL−1 in sham (*p < 0.0001). Hct (11.2% vs 25.1 %, *p = 0.01) and RBCs (3.7 vs 8.2 × 106/µl, *p = 0.003) also decreased. The relative number of platelets compared to baseline was different (55.6 ± 10.6% vs. 100 ± 0 %, *p = 0.004), but no hemorrhage was observed. White blood cells (WBCs), lactate, prothrombin ratio and activated partial thromboplastin time (aPTT) remained within similar ranges. Conclusions: Critical normovolemic anemia without bleeding complications was successfully reached by selective RBC depletion in sheep. Investigations of physiological adaptations to severe anemia and pharmaceutical testing can be performed in large animals with depleted RBCs.

Fluid resuscitation with balanced electrolyte solutions results in faster resolution of diabetic ketoacidosis than with 0.9% saline in adults – A systematic review and meta‐analysis

AbstractFluid resuscitation during diabetic ketoacidosis (DKA) is most frequently performed with 0.9% saline despite its high chloride and sodium concentration. Balanced Electrolyte Solutions (BES) may prove a more physiological alternative, but convincing evidence is missing. We aimed to compare the efficacy of 0.9% saline to BES in DKA management. MEDLINE, Cochrane Library, and Embase databases were searched for relevant studies using predefined keywords (from inception to 27 November 2021). Relevant studies were those in which 0.9% saline (Saline‐group) was compared to BES (BES‐group) in adults admitted with DKA. Two reviewers independently extracted data and assessed the risk of bias. The primary outcome was time to DKA resolution (defined by each study individually), while the main secondary outcomes were changes in laboratory values, duration of insulin infusion, and mortality. We included seven randomized controlled trials and three observational studies with 1006 participants. The primary outcome was reported for 316 patients, and we found that BES resolves DKA faster than 0.9% saline with a mean difference (MD) of −5.36 [95% CI: −10.46, −0.26] hours. Post‐resuscitation chloride (MD: −4.26 [−6.97, −1.54] mmoL/L) and sodium (MD: −1.38 [−2.14, −0.62] mmoL/L) levels were significantly lower. In contrast, levels of post‐resuscitation bicarbonate (MD: 1.82 [0.75, 2.89] mmoL/L) were significantly elevated in the BES‐group compared to the Saline‐group. There was no statistically significant difference between the groups regarding the duration of parenteral insulin administration (MD: 0.16 [−3.03, 3.35] hours) or mortality (OR: −0.67 [0.12, 3.68]). Studies showed some concern or a high risk of bias, and the level of evidence for most outcomes was low. This meta‐analysis indicates that the use of BES resolves DKA faster than 0.9% saline. Therefore, DKA guidelines should consider BES instead of 0.9% saline as the first choice during fluid resuscitation.

Prolonged hyperinsulinemia increases the production of inflammatory cytokines in equine digital lamellae but not in striated muscle

Hyperinsulinemia is the key feature of equine metabolic syndrome (EMS) which leads to debilitating sequelae. Hyperinsulinemia-associated laminitis (HAL) is one of the major sequelae of EMS, although the pathophysiological mechanisms are not well elucidated. Using an equine model, we hypothesized that expression of inflammatory markers would be increased in digital lamellae and striated muscle following prolonged hyperinsulinemia. Healthy Standardbred horses (5.4 ± 1.9 years) were alternately assigned to a prolonged euglycemic-hyperinsulinemic clamp (pEHC) or control group (n = 4 per group). Following a 48 h pEHC or a 48 h infusion of a balanced electrolyte solution (controls), biopsies were collected from digital lamellar tissue, skeletal muscle and cardiac muscle were obtained. All hyperinsulinemic horses developed laminitis regardless of previous health status at enrollment. Protein expression was quantified via Western blotting. A significant (P < 0.05) upregulation of the protein expression of heat shock protein 90 (HSP90), alpha 2 macroglobulin (A2M) and fibrinogen (α, β isoforms), as well as inflammatory cytokines including interleukin-1β were detected in digital lamellae following prolonged hyperinsulinemia. In contrast, protein expression of cytokines and acute phase proteins in heart and skeletal muscle was unchanged following hyperinsulinemia. Upregulation of inflammatory cytokines and acute phase proteins in digital lamellae during prolonged hyperinsulinemia may reveal potential biomarkers and novel therapeutic targets for equine endocrinopathic laminitis. Further, the lack of increase of inflammatory proteins and acute phase proteins in striated muscle following prolonged hyperinsulinemia may highlight potential anti-inflammatory and cardioprotective mechanisms in these insulin-sensitive tissues.

Comparing the clinical effects of balanced electrolyte solutions versus normal saline in managing diabetic ketoacidosis: A systematic review and meta-analyses.

The first-line treatment of diabetes ketoacidosis (DKA) involves fluid resuscitation with normal saline infusion to correct hypovolemia. Hyperchloremic metabolic acidosis from aggressive normal saline administration was associated with worse clinical outcomes in managing DKA. Other choices for normal saline include balanced electrolyte solutions (BESs). This study aimed to compare the clinical effects between BESs and normal saline in managing DKA. This study was a systematic review of probing articles published from inception to October 2021 in Cochrane Central Register of Controlled Trials, Medical Literature Analysis and Retrieval System Online, Google Scholar, and Scopus. Eight randomized controlled trials with a total of 595 individuals were included. The data were analyzed at 95% confidence level using random-effects models. For the primary outcomes, there was no difference in the duration of DKA resolution. (Mean difference [MD] -4.73, 95% confidence interval [CI] -2.72-4.92; I2 = 92%; P = 0.180). However, there was a significantly lower postresuscitation chloride concentration in the BES (MD 2.96 95% CI - 4.86 to - 1.06; I2 = 59%; P = 0.002). For the secondary outcomes, there was a significant reduction in duration for normalization of bicarbonate in the BES group (MD 3.11 95% CI - 3.98-2.23; I2 = 5%; P = 0.0004). There were no significant differences between groups in duration for recovery of pH, intensive unit admission, and adverse events (mortality and acute renal failure). Resuscitation with BES was associated with decreased chloride and increased bicarbonate values in DKA patients. It suggests that BES prevents DKA patients from hyperchloremic metabolic acidosis.

Plasma-Lyte-148 Versus Normal Saline 0.9% in Diabetic Ketoacidosis Management: A Review.

Diabetic ketoacidosis (DKA) is a critical complication of diabetes mellitus characterized by hyperglycemia, ketonemia, circulatory collapse, hypokalemia, and metabolic acidosis. The therapeutic management of DKA includes vigilant fluid resuscitation to address dehydration and electrolyte imbalances and restore hemodynamic stability. The choice of fluid, either isotonic saline or a balanced electrolyte solution like Plasma-Lyte 148 (PL), is pivotal in the clinical outcomes of DKA patients. Recent studies have compared the effectiveness of these fluid solutions in DKA management, focusing on different clinical outcomes such as the resolution of metabolic acidosis, electrolyte imbalances, the incidence of acute kidney injury, and length of hospital stay. This review examines the literature comparing isotonic saline and balanced electrolyte solutions for fluid resuscitation in DKA, analyzing the associated clinical outcomes. Through synthesizing research findings, this review aims to elucidate the efficacy and potential advantages of utilizing PL as an alternative to traditional isotonic saline for fluid resuscitation in treating DKA. This would further facilitate evidence-based decision-making among healthcare professionals and contribute to optimizing DKA management strategies. Understanding the intricacies and implications of fluid resuscitation is crucial, given its profound impact on patient outcomes in DKA management.

Y-site administration of electrolyte solutions and injectable acetaminophen-A physical compatibility study with combinations frequently used in pediatric intensive care and anesthesia.

Determination of the physical compatibility of acetaminophen and two different electrolyte solutions (an isotonic, balanced electrolyte solution and a hypotonic, glucose containing electrolyte solution) with drugs frequently used in routine pediatric intensive care. Analytical investigations for frequently used combinations without pre-existing data were performed. Visual and microscopic observations according to the European Pharmacopeia as well as pH measurements and ultraviolet visible spectrometry at wavelengths of 350, 410 and 550 nm were conducted to analyze physical compatibility. All measurements were performed immediately after mixing as well as 1, 4, and 24 h after. In total, 42 combinations were analyzed. Visual incompatibilities were found with pantoprazole and diazepam with both electrolyte solutions. For furosemide, a particle formation in mixture with the hypotonic glucose-containing electrolyte solution and a change in pH ≥ 0.5 after 24 h with both electrolyte solutions were observed. Ampicillin, cefuroxime, diazepam, furosemide, linezolid, meropenem, and pantoprazole showed an aberration of the absorbance ≥0.04 (350 nm/410 nm) or ≥0.01 (550 nm) in the photometric measurements with the electrolyte solutions. For acetaminophen, a physical incompatibility was observed with ampicillin, diazepam, furosemide, and pantoprazole. Most of the analyzed combinations showed no signs of physical incompatibility and may therefore be administered via the same Y-site. However, diazepam, furosemide, and pantoprazole should not be administered simultaneously with acetaminophen or both electrolyte solutions.

Comparison of capillary blood glucose level at 1 h after induction of general anesthesia in children receiving intraoperatively either Ringer’s lactate with glucose 1% or Ringer’s lactate alone

Background: Perioperative fluid therapy in children is quite challenging job for anesthesiologists. Variable glycemic control has been reported in the literature regarding the use of balanced electrolyte solution with or without 1–2% glucose supplementation. Aims and Objectives: Hence, this study was planned to determine the capillary blood glucose level (CBG) in the intraoperative period at 1 h after induction of general anesthesia in children (1–6 years of age) receiving either Ringer’s lactate (RL) with glucose 1% or RL alone. Materials and Methods: A total of 60 patients of either gender, aged 1–6 years, of American Society of Anesthesiologists Physical Status Classes 1 and 2 were included for this interventional study. All children received protocolized general anesthesia with strict adherence to standard fasting guidelines. The children received either RL alone (Group A, n=30) or RL plus 1% glucose solution (Group B, n=30) as intraoperative fluid. The pre-operative CBG was recorded. Intraoperative fluid was given at 10 mL/kg/hr. The CBG was checked again at 30 min and 1 h after induction of anesthesia. The glycemic status at 1 h in the intraoperative period was compared (primary outcome) between the two groups. Results: The hemodynamics and intraoperative consumption of fluid were comparable between the groups. The mean CBG values at 30 min and at 1st h were considerably higher in groups receiving RL with 1% glucose compared with those receiving RL alone. However, these differences were not clinically significant. No adverse event was observed. Conclusion: RL alone or RL plus glucose 1% can be used as intraoperative fluid in children (1–6 years of age). None developed clinically significant hypoglycemia or hyperglycemia. However, the optimal amount of glucose which can be safely used in the perioperative period needs to be determined with a larger trial.

The impact of modified fluid gelatin 4% in a balanced electrolyte solution on plasma osmolality in children-A noninterventional observational study.

Intravenous fluids for perioperative infusion therapy should be isotonic to maintain the body fluid homeostasis in children. Modified fluid gelatin 4% in a balanced electrolyte solution has a theoretical osmolarity of 284 mosmol L-1 , and a real osmolality of 264 mosmol kg H2 O-1 . Because both values are lower than those of 0.9% saline or plasma, gelatin would be expected to be hypotonic in-vitro and in-vivo. We thus hypothesized that the infusion of gelatin would be expected to decrease plasma osmolality. We performed an in-vitro experiment and an in-vivo study to evaluate the impact of gelatin on the osmolality in children. In the in-vitro experiment, full blood samples were diluted with gelatin 4% or albumin (50 g L-1 ) from 0% (pure blood) to 100% (pure colloid), and the osmolality was measured by freezing-point depression. In the in-vivo study, blood gas analyses from children undergoing major pediatric surgery were collected before and after gelatin infusion, and the osmolality was calculated by a modified version of Zander's formula. In the in-vitro experiment, 65 gradually diluted blood samples from five volunteers (age 25-55 years) were analyzed. The dilution with gelatin caused no significant changes in osmolality between 0% and 100%. Compared with gelatin, the osmolality in the albumin group was significantly lower between 50% and 100% dilution (p < .05). In the in-vivo study, 221 children (age 21.4 ± 30 months) were included. After gelatin infusion, the osmolality increased significantly (mean change 4.3 ± 4.8 [95% CI 3.7-4.9] mosmol kg H2 O-1 ; p < .01) within a normal range. Gelatin in a balanced electrolyte solution has isotonic characteristics in-vitro and in-vivo, despite the low theoretical osmolarity, probably caused by the (unmeasured) negative charges in the gelatin molecules contributing to the plasma osmolality. For a better evaluation of the (real) tonicity of gelatin-containing solutions, we suggest to calculate the osmolality (mosmol kg H2 O-1 ) using Zander's formula. ClinicalTrials.gov (ID: NCT02495285).

MICROVASCULAR AND METABOLIC EFFECTS OF A BALANCED ELECTROLYTE SOLUTION AND HEPARINIZED AUTOLOGOUS BLOOD IN HEMORRHAGIC SHOCK

Aim: To compare the microvascular and metabolic effects of autologous blood and a balanced electrolyte solution (BES) containing acetate and malate in hemorrhagic shock (HS) in rats. Methods. The experiments were carried out on male Wistar rats (n=21) under general anesthesia. Blood (35% of estimated blood volume) was withdrawn for 5 minutes. After 60 minutes of HS the collected blood was retransfused, followed by the infusion of BES in the volume of 50% of the blood loss (HS+AB group); HS+BES group received BES in a triple volume of blood loss; a sham-hemorrhage control. Heart rate (HR), mean arterial pressure (MAP), skin blood flow (M), gases and acid-base state of arterial blood, post-occlusive reactive hyperemia (PORH) in the rat tail, serum levels of biomarkers S100b and NSE were assessed after 24 hours. After euthanasia, a histological examination of the brain, lungs, heart and kidneys was performed. Results. In HS+AB and HS+BES groups, 24-hour mortality did not differ (one animal in each group). MAP in these groups was moderately reduced compared to sham group. There were no significant differences in HR, M, acid-base state, PORH and levels of S100b and NSE between the groups. Histological examination revealed circulatory disorders of varying severity in groups with hemorrhage, with more pronounced damage to the brain and kidneys in HS+BES group. Conclusion. Both autologous blood and BES containing acetate and malate equally restore MAP, skin microcirculation, and acid-base state 24 hours after HS. However, fluid resuscitation with BES alone is associated with brain and kidney damage.

Hypoglycaemia associated with variable rate intravenous insulin infusion and concurrent administration of balanced electrolyte solution: A single hospital experience

Hypoglycaemia associated with variable rate intravenous insulin infusion and concurrent administration of balanced electrolyte solution: A single hospital experience

Developing a Solution for Nasal and Olfactory Transport of Nanomaterials.

With advances in nanotechnology, engineered nanomaterial applications are a rapidly growing sector of the economy. Some nanomaterials can reach the brain through nose-to-brain transport. This transport creates concern for potential neurotoxicity of insoluble nanomaterials and a need for toxicity screening tests that detect nose-to-brain transport. Such tests can involve intranasal instillation of aqueous suspensions of nanomaterials in dispersion media that limit particle agglomeration. Unfortunately, protein and some elements in existing dispersion media are suboptimal for potential nose-to-brain transport of nanomaterials because olfactory transport has size- and ion-composition requirements. Therefore, we designed a protein-free dispersion media containing phospholipids and amino acids in an isotonic balanced electrolyte solution, a solution for nasal and olfactory transport (SNOT). SNOT disperses hexagonal boron nitride nanomaterials with a peak particle diameter below 100 nm. In addition, multiwalled carbon nanotubes (MWCNTs) in an established dispersion medium, when diluted with SNOT, maintain dispersion with reduced albumin concentration. Using stereomicroscopy and microscopic examination of plastic sections, dextran dyes dispersed in SNOT are demonstrated in the neuroepithelium of the nose and olfactory bulb of B6;129P2-Omptm3Mom/MomJ mice after intranasal instillation in SNOT. These findings support the potential for SNOT to disperse nanomaterials in a manner permitting nose-to-brain transport for neurotoxicity studies.

Estimated glomerular filtration rate decreased by Hydroxyethyl Starch in isolated coronary artery bypass graft surgery: A retrospective cohort study

Background/Aim: Hydroxyethyl starches have been widely used to replace the intravascular volume. They increase the risk of renal injury in critically ill patients. In cardiac surgery, patients are at risk for cardiac surgery-associated acute kidney injury. This study aims to analyze the renal functions in coronary surgery with hydroxyethyl starches and crystalloids. Methods: Patients who underwent isolated on-pump coronary artery bypass graft surgery between January 2017 and June 2019 were included in the study. They were categorized into two groups according to intraoperative volume replacement therapy. The non-HES group consisted of patients who had been given a balanced electrolyte solution; the HES group consisted of patients who were administered a balanced electrolyte solution and 500 ml of hydroxyethyl starch solution. A two-sided P-value of 0.05). In the HES group, the postoperative value of creatinine was significantly higher and estimated glomerular filtration rate level was significantly lower compared to the preoperative values (P

Comparison the effects of using two methods of fluid therapy with normal saline or 5% dextrose in half amount of normal saline solution on blood glucose and plasma electrolytes during and after neonatal surgeries: A randomized controlled trial

Background: Nowadays, with or without sugar, balanced electrolyte solutions are used to prevent hyponatremia, hypoglycemia, and hyperglycemia for neonatal fluid therapy. Objectives: This study aimed to compare the effects of two types of fluid therapy with normal saline and 5% dextrose in half amount of normal saline (DW5% NaCl 0.45%) solution on plasma electrolytes and blood glucose during and after surgery in neonates. Methods: The research population consisted of 1-day to 30-day-old infants who were candidates for surgery under general anesthesia; 70 infants were selected and assigned by block randomization in two groups of 35. Patients in Group A received fluid therapy with normal saline 0.9% (10 cc/kg/h) and DW 5% NaCl 0.45% solution in Group B (10 cc/kg/h). Results: There was no significant difference in the mean value of bicarbonate level (HCO3), base excess and blood acidity (pH) in the study groups (P > 0.05). In Group A, there was no significant difference in sodium (Na) and mean arterial pressure (MAP) over time (P > 0.123), while in Group B, Na level decreased and MAP increased significantly (P < 0.05) with time. Blood sugar levels increased significantly in both groups over time, although this increase was greater in Group B. Conclusion: In general, the results of the study showed that both fluid therapy with normal saline and DW5% NaCl 0.45% solutions can be used in neonatal surgery, but based on the studied variables in this work, normal saline has a lower risk of hyperglycemia than DW5% NaCl 0.45% solution and therefore it is preferred.

Crystalloid fluids and delayed graft function in kidney transplant: A cohort study.

Background:Normal saline is commonly used in the perioperative kidney transplant period; its high chloride content can cause hyperchloremic metabolic acidosis giving a possible advantage to balanced electrolyte solutions due to their lower chloride content. The evidence regarding the best practices in fluid management during kidney transplantation and its effect on the incidence of delayed graft function (DGF) is still limited.Materials and Methods:One hundred thirty-eight patients were included and followed up for seven days after surgery. Administered crystalloid type and volume were compared among patients with and without DGF, along with additional patient and surgical variables. To investigate whether intraoperative fluid type/amount influence DGF, patients were categorized into three groups: those who received mainly (>50%) lactated Ringer's solution, normal saline, or plasmaLyte. A logistic regression analysis was used to define variables independently correlated with DGF, and odds ratios (OR) with a 95% confidence interval (CI) were reported.Results:The incidence of DGF was 8.7%. Cold ischemia time independently increased the odds of DGF (OR = 1.006 (95% CI: 1.002–1.011) while fluid type (saline versus PlasmaLyte OR = 5.28, 95% CI: 0.76–36.88) or amount (OR = 1.00, 95% CI: 1.00–1.01) did not significantly modify the odds of DGF. Central venous pressure, systolic blood pressure, and mean arterial pressure were higher in the non-DGF group, but this was not statistically significant (P > 0.05). Significant intraoperative acidosis developed in patients who received normal saline compared to those in PlasmaLyte and lactated Ringer's groups; however, acid–base balance and electrolytes did not vary significantly between the DGF and non-DGF groups.Conclusion:DGF was primarily influenced by surgical factors such as cold ischemia time, whereas intraoperative fluid type or amount did not affect DGF incidence.

Лекарственно-индуцированная кристаллическая нефропатия

Drug-induced (DI) crystal nephropathy (CN) is a relatively rare kidney disease that is not always easy to diagnose and potentially leads to acute kidney injury (AKI), which may lead to the need for haemodialysis and is associated with a high risk of mortality. Th e aim of the review was analysis and systematisation of data on drugs, the intake of which is associated with development of DICN, conditioning the increased risk of drug-induced AKI, on its pathophysiological mechanisms, analysis of possible methods of treatment and prevention. The search for the specifi ed keywords was carried out in the eLIBRARY.RU, PubMed®, MEDLINE, EMBASE databases, guidelines and methodological recommendations, materials of databases of adverse reactions, instructions for the medical use of drugs published within the period up to June 2021. Most often, DICN is associated with the use of such drugs as sulfadiazine, acyclovir, indinavir, triamterene, methotrexate, as well as orlistat, ciprofl oxacin, amoxicillin, oral sodium phosphate preparations, etc. Th e main pathophysiological mechanism of CN development is the precipitation of poorly soluble substances in the urine and formation of crystals. Th ereat, one part of the drug crystallises and the precipitate falls out directly into the renal tubules, the other part acts through a change in metabolism, increasing the concentration of other poorly soluble compounds in the urine. The risk factors for DICN include the risk factors for AKI as well as drug-specifi c risk factors, such as urine pH. Clinically, СN is most oft en manifested by symptoms of AKI, sometimes with development of acute renal colic and hematuria. In СN treatment, it is required to cancel the inducer drug or reduce its dose, stimulate diuresis with replenishment of the intravascular fluid volume using infusions of balanced electrolyte solutions. For the prevention of DICN, it is important to take into account all possible risk factors for its development, use adequate doses of drugs and avoid the prescription of potentially nephrotoxic drugs

Complications from normal saline in thulium laser enucleation of the prostate

Systemic fluid absorption frequently occurs during endoscopic prostatic surgery. The introduction of lasers allowed the use of normal saline (0.9% sodium chloride). We report 2patients who developed hyperchloremic metabolic acidosis and isotonic hypervolemia during thulium laser enucleation of the prostate (ThuLEP) and required prolonged ventilation time, catecholamines, intensive care and prolonged hospitalization. Achange to balanced electrolyte solutions in urology-as is already established in infusion and volume therapy-would be desirable, especially to avoid hyperchloremic metabolic acidosis.

Pharmacological therapy of circulatory shock

Circulatory shock requires treatment of the underlying pathology in addition to supportive pharmacological therapy that is guided by hemodynamic monitoring. Based on the evaluation of the patient's volume, perfusion and cardiac status, the following therapeutic goals should be achieved: (1)Normalization of the intra- and extravascular fluid volume. (2)Provision of sufficient perfusion pressure and organ perfusion. (3)Optimization of cardiac function including protecting an ischemic and exhausted myocardium from overload. The most important therapeutic substances are balanced electrolyte solutions and the vasopressor noradrenaline. Because there is little scientific evidence for the use of alternative drugs, these should only be given if there is agood pathophysiologic rationale and if their effect is continuously monitored and re-evaluated.

Expert consensus on the use of human serum albumin in critically ill patients.

Expert consensus on the use of human serum albumin in critically ill patients.

A survey of emergency and critical care veterinarians regarding IV fluid bolus therapy and monitoring practices in small animals.

To determine how veterinary emergency and critical care clinicians define IV fluid bolus therapy (FBT) and what constitutes a positive response to a fluid bolus. Online survey of 222 emergency and critical care veterinarians between December 17, 2018, and March 1, 2019. An online survey was provided to diplomates of the American College of Veterinary Emergency and Critical Care (ACVECC), residents of ACVECC-approved training programs, as well as house officers and emergency clinicians of a corporate multicenter emergency and specialty care veterinary hospital. The survey investigated the administration of various crystalloid, colloid, and blood products for FBT, as well as expected physiological responses. The majority of respondents considered balanced isotonic crystalloids appropriate for FBT (220/222 [99.1%]). Respondents showed greater variability in acceptance of 0.9% sodium chloride (105/222 [47.30%]), hypertonic (3-7%) sodium chloride (131/222 [59.01%]), and hydroxyethyl starch solutions (90/222 [40.54%]). Most respondents did not consider physiological plasma (44/222 [19.82%]) an appropriate choice. The most commonly used parameters for monitoring FBT responses were heart rate (220/222 [99.10%]), blood pressure (217/222 [97.75%]), capillary refill time (192/222 [86.49%]), lactate (181/222 [81.53%]), pulse pressure (151/222 [68.02%]), and rectal temperature (145/222 [65.32%]). The majority of respondents perceived that 0-20% (165/222 [74.32%]) of hypotensive patients are nonresponsive to FBT. Small animal emergency and critical care clinicians favored balanced isotonic electrolyte solutions and hypertonic sodium chloride solutions for FBT over other options. When monitoring responses to FBT, heart rate, blood pressure, capillary refill time, and plasma lactate were among the most commonly monitored parameters, and there was a lack of familiarity with others. Despite the widespread use of FBT, these findings outline the need for further prospective clinical trials regarding the ideal fluid type and rate, as well as the appropriate responses to FBT.