Balanced Salt Solutions Research Articles

Comparing the Corrosion Behavior and Microstructure of a WE43 Mg Alloy in Simulated Body Fluids Under Different CO2 Conditions

With the low density and high specific strength, magnesium (Mg) alloys are lightweight alloys with various applications. In addition, combined with biocompatibility, similar mechanical properties to human bones, and unique biodegradability, Mg alloys are promising biodegradable implant materials for orthopedic surgeries. However, the degradation rates of Mg alloys are too fast in physiological environments, which limits the clinical applications of Mg implants. Therefore, understanding the corrosion behavior in physiological environments is crucial for developing biodegradable Mg alloys.During Mg alloy degradation, hydroxide (OH-) ions are generated, and the pH near the alloy surface increases. Since carbonate-bicarbonate (CO3 2--HCO3 -) is a vital pH buffer system in the human body, the corrosion behavior of Mg alloys would be affected by the CO2 concentrations of the test environments. In this study, we performed electrochemical and corrosion tests of a solution heat-treated WE43 (Mg-4 wt%Y-3 wt%Nd) alloy in Hanks’ balanced salt solutions (HBSS) at 37°C. By performing the tests in air and in an incubator maintained at 5% CO2, the effect of carbonate-bicarbonate pH buffering on the corrosion behavior and corrosion microstructure of the WE43 Mg alloy was investigated.When testing the WE43 Mg alloy in air, a general corrosion morphology was observed during the 24-hour immersion. In contrast, WE43 Mg alloy tested in the incubator shows a more active surface potential and localized corrosion initiates on the alloy surface in the early stages of immersion. Electrochemical impedance spectroscopy (EIS) analysis shows that WE43 Mg alloy tested in air has better corrosion resistance than in the incubator. Furthermore, the corrosion resistance of the alloy tested in air increases with immersion time but decreases when tested in the incubator. Potentiodynamic polarization curves after 24-hour immersion confirm that the corrosion current density (i corr) of the WE43 Mg alloy tested in the incubator is higher than that when tested in air. The difference in corrosion behavior is owing to the carbonate-bicarbonate pH buffering effect and will be discussed based on corrosion microstructure characterizations. Figure 1

Evaluation of vision-related quality of life in patients after vitrectomy following idiopathic epiretinal membrane.

To evaluate the impact of different intraocular tamponades on the visual-related quality of life (VRQOL) after idiopathic epiretinal membrane (IEM) surgery with epiretinal membrane peeling. We prospectively enrolled 50 patients diagnosed with IEM who underwent pars plana vitrectomy (PPV). Patients were consecutively assigned to either the air tamponade (air) group (25 patients) or the balanced salt solutions (BSS) tamponade group (25 patients). The following data were collected before and after surgery and compared between two groups: VRQOL, best corrected visual acuity (BCVA), intraocular pressure (IOP), metamorphopsia, contrast sensitivity (CS), and central macular thickness (CMT). PPV was performed in 50 eyes. At baseline, there were no significant differences between the two groups. At 6 months postoperatively, VRQOL (p < 0.001), BCVA (p < 0.001), CMT (p < 0.001), CS (p < 0.001), and metamorphopsia (p < 0.001) improved significantly in comparison to baseline, without significant differences between the air tamponade and BSS groups. Removing IEM significantly improved visual function and VRQOL. Despite improvements, our study showed no difference postoperatively whether air or BSS tamponade was used during surgery. As a result, air tamponade may not be a mandatory treatment for IEM surgery and provides no additional advantage compare with BSS tamponade.

AUGS-IUGA Joint Clinical Consensus Statement on Enhanced Recovery After Urogynecologic Surgery

AUGS-IUGA Joint Clinical Consensus Statement on Enhanced Recovery After Urogynecologic Surgery

ACE Question

Article| September 2022 ACE Question ASA Monitor September 2022, Vol. 86, 13. https://doi.org/10.1097/01.ASM.0000874216.72620.21 Views Icon Views Article contents Figures & tables Video Audio Supplementary Data Peer Review Share Icon Share Facebook Twitter LinkedIn MailTo Cite Icon Cite Get Permissions Search Site Citation ACE Question. ASA Monitor 2022; 86:13 doi: https://doi.org/10.1097/01.ASM.0000874216.72620.21 Download citation file: Ris (Zotero) Reference Manager EasyBib Bookends Mendeley Papers EndNote RefWorks BibTex toolbar search Search Dropdown Menu toolbar search search input Search input auto suggest filter your search All ContentAll PublicationsASA Monitor Search Advanced Search Topics: anesthesiology continuing education (ace) Which of the following complications is MOST likely to be associated with vasa previa? Vasa previa (Figure) is a velamentous insertion of the fetal vessels overlying the cervical os ahead of the fetal presenting part. This leaves the fetal vessels unprotected by the placenta or umbilical cord and at risk of being compressed by the fetal presenting part or disrupted during rupture of the fetal membranes. There is a high risk of fetal mortality due to exsanguination, as the blood volume of the term fetus is only 80 to 100 mL/kg. Immediate cesarean delivery is required, with the largest focus being on expedient delivery of the fetus and subsequent volume resuscitation of the fetus with colloid, balanced salt solutions, or blood transfusion. The two main causes of vasa previa are velamentous insertions (where the cord inserts directly into the membranes, leaving unprotected vessels running to the placenta) and... You do not currently have access to this content.

Comment: Balanced Salt Solutions for Critically Ill Patients: Nonplused and Back to Basics.

The analysis of trial results of the intravenous fluids pharmacodynamics revealed problems common to all studies, such as varying study designs, clinical discretion for treatments, and heterogeneous patients. We believe that in the methodology of future research it is also necessary to pay due attention to the actual rather than theoretical physicochemical parameters of the solutions used, such as osmolality, pH, and potential excess of bases. Paying attention to these parameters of intravenous fluids will be useful for assessing their role in producing pharmacodynamic effects in critically ill patients.

Modified Fluid Gelatin Versus Crystalloids in CABG Surgery Patients: a Propensity Score Matched Analysis

The objective: to compare efficacy and safety of infusion therapy with modified fluid gelatin ( MFG ) and balanced salt solutions. Subjects and Methods. 1,820 patients after coronary artery bypass grafting were enrolled in the retrospective study. Two groups of 362 patients were formed by the matching index method. Results. Primary endpoints. Acute kidney injury ( AKI ) developed less frequently in the crystalloid group compared to the colloid group, also more patients in the colloid group received fresh frozen plasma and red blood cells. In the crystalloid group, the duration of stay in the intensive care unit ( ICU ) decreased, while the duration of mechanical ventilation increased. The use of MFG within infusion therapy made it possible to reduce the volume of balanced salt solutions transfused both in the perioperative period and during stay in the intensive care unit. However, there was no intergroup difference in the total volume of infusion therapy calculated based on the patient's actual weight. Conclusions. The use of MFG as part of infusion therapy may increase the incidence of AKI , the need for transfusion of blood components, as well as the duration of stay in ICU . Use of MFG was associated with shorter duration of mechanical ventilation.

Comparison of normal saline and balanced salt solution as a maintenance fluid on acids-base and electrolyte status in traumatic brain injury patients; a prospective randomized double-blind study

Background &amp; objective: Normal saline is the most commonly used fluid in traumatic brain injury (TBI) patients both in resuscitation and maintenance since long time but associated with hyperchloremic metabolic acidosis. Balanced salt solutions (BSS) are recently developed with favorable outcome in resuscitation and intraoperative as a maintenance fluid. We compared normal saline and BSS as maintenance fluids in TBI patients admitted to intensive care unit.&#x0D; Methodology: After institutional ethical committee approval and written informed consent from patients’ relatives, 100 patients who meet inclusion criteria were randomly divided into two equal groups; Group NS: to receive normal saline as a maintenance fluids and Group BSS: to receive BSS as a maintenance fluid. Data of serum electrolyte and acid base status were collected on day 1, 3, 5, 7 and 14. Patient outcome was evaluated on day-8. Data was analyzed with appropriate statistical tests. The P &lt; 0.05 indicated that the difference was significant.&#x0D; Results: In both groups pH gradually increased over time and was more alkaline in normal saline group. Base excess was comparable between two groups. In normal saline group, serum sodium and chloride increased gradually and reached on the higher side on day-14, while potassium level dropped to a lower side. Twenty-eight days mortality was more in Group NS than the Group BSS.&#x0D; Conclusion: Balanced salt solution causes lesser alterations in acid base and electrolyte status than the normal saline and is associated with more favorable outcome.&#x0D; Abbreviations: TBI - Traumatic brain injury; BBB - Blood brain barrier; BSS - Balanced salt solution; ABG - Arterial blood gas analysis; GCS - Glasgow Comma Scale; RFT’s - Renal function tests; BE - Base excess&#x0D; Key words: Ringer's lactate; Sodium Chloride / pharmacology; Balanced salt solution; Double-Blind Method; Humans; Hydrogen-Ion Concentration; Isotonic Solutions / pharmacology; Potassium / blood&#x0D; Citation: Shephali, Singh Y, Mishra M, Sachan S, Pathak NM, Shankar R. Comparison of normal saline and balanced salt solution as a maintenance fluid on acids-base and electrolyte status in traumatic brain injury patients; a prospective randomized double-blind study. Anaesth. pain intensive care 2022;26(3):326-331. &#x0D; DOI: 10.35975/apic.v26i3.1899&#x0D; Received: December 18, 2021; Reviewed: January 25, 2022; Accepted: February 02, 2022&#x0D;

Balanced Salt Solutions for Critically Ill Patients: Nonplused and Back to Basics.

The purpose of this article is to summarize the results of major randomized controlled trials (RCTs) comparing clinical outcomes of critically ill patients treated with normal saline (NS) or balanced salt solutions (BSSs), address discordant results of these studies, and provide direction for future investigations. PubMed (2011 to January 2022) with bibliographies of retrieved articles searched for additional articles. RCTs comparing NS and BSSs in critically ill adult patients. Recently published large RCTs comparing NS with BSSs in heterogeneous populations of intensive care unit patients did not find significant differences in mortality, despite positive findings in some end points in prior RCTs. However, there were a number of methodologic issues common to the RCTs including: varying study designs and end points, clinician discretion for the majority or all treatments other than the primary intervention fluid, heterogeneous patients with varying levels of acuity, and lack of power to investigate potential subgroup differences. In addition, there were problematic issues related to blinding and use of nonstudy fluids. Intravenous fluids are a mainstay of supportive care for critically ill patients. Similar to the so-called crystalloid-colloid debate, there has been a long-standing debate among critical care clinicians and researchers concerning the preferred crystalloid solution, NS versus one of the available BSSs. Despite the recent publication of large multicenter RCTs, the preferred resuscitation fluid, NS or a BSS, for critically ill patients is still open for debate, although the available investigations do provide some direction for clinicians and for future investigations.

Місце збалансованих інфузійних розчинів на основі лактату натрію в сучасній інфузійній терапії

Даний огляд присвячений проблемі використання збалансованих полііонних розчинів із носієм резервної лужності — лактатом натрію, їх місцю в сучасній інфузійній терапії. Показано, що, незважаючи на відносно довгий період після відкриття перших збалансованих багатокомпонентних сольових розчинів із лактатом, вони залишаються актуальними і затребуваними в клінічній практиці. Поява нового покоління полііонних багатофункціональних розчинів викликала значний інтерес у середовищі клініцистів. Багато робіт характеризують їх як ефективні та відносно безпечні лікарські засоби, що знайшли своє місце в лікуванні критичних і невідкладних станів.

Normal Saline Versus Balanced Crystalloids in Renal Transplant Surgery: A Double-Blind Randomized Controlled Study.

BackgroundThe importance of optimal acid-base balance during renal transplant surgeries cannot be stressed enough. Optimal preload and electrolyte balance is important in maintaining this. There has been a debate on the choice of perioperative crystalloids in renal transplant surgeries over the past decades. Normal saline (0.9% saline) is more likely to cause hyperchloremic acidosis when compared to balanced salt solutions (BSS) with low chloride content whereas BSS may cause hyperkalemia. We aim to compare the safety and efficacy of normal saline (NS), Ringer’s lactate (RL) and Plasmalyte (PL) on acid-base balance and electrolytes during living donor kidney transplantation.Materials and methodsPatients were randomized to NS group (n = 60), RL group (n = 60) and Plasmalyte group (n = 60). Arterial blood samples were collected for acid-base analysis after induction of anaesthesia (T0), prior to clamping the iliac vein (T1), 10 minutes after reperfusion of the donated kidney (T2) and at the end of surgery (T3). In addition, serum creatinine and 24-hour urine output were recorded on postoperative days one, two and seven.ResultsThere was a statistically significant difference (p < 0.001) in the pH at the end of surgery between the three groups with the NS group being more acidotic (pH 7.29 ± 0.06, 95% CI 7.27-7.32), although this was not clinically relevant. This was explainable by the parallel increase in chloride in the NS group. Early postoperative graft functions in terms of serum creatinine, urine output and graft failure requiring dialysis were not significantly different between the groups.ConclusionBalanced salt solutions such as Plasmalyte and Ringer’s lactate are associated with better pH and chloride levels compared to normal saline when used intraoperatively in renal transplant patients. This difference, however, does not appear to have any bearing on graft function. Plasmalyte seems to maintain a better acid-base and electrolyte balance, especially during the postreperfusion period.

Normal saline or balanced salt solutions for fluid administration with a focus on critical care and emergency medicine settings.

In an effort to expedite the publication of articles , AJHP is posting manuscripts online as soon as possible after acceptance. Accepted manuscripts have been peer-reviewed and copyedited, but are posted online before technical formatting and author proofing. These manuscripts are not the final version of record and will be replaced with the final article (formatted per AJHP style and proofed by the authors) at a later time.

Biodegradation behaviour of Fe-based alloys in Hanks’ Balanced Salt Solutions: Part I. material characterisation and corrosion testing

Research on Fe-based biodegradable alloys for implant applications has increased considerably over the past decade. However, there is limited information on the influence of testing electrolytes on corrosion product formation and general corrosion progress. In this work, the effect of Hanks’ Balanced Salt Solution (HBSS) with or without Ca2+ on the corrosion of Fe, Fe35Mn and (Fe35Mn)5Ag powder-processed coupons has been studied using potentiodynamic polarisation, Electrochemical Impedance Spectroscopy (EIS), and preliminary localised measurement of pH and dissolved oxygen concentration in close proximity to the metal surface. Both Fe35Mn and (Fe35Mn)5Ag alloys showed accelerated corrosion when compared to pure Fe based on potentiodynamic testing results, with FeMnAg exhibiting the highest corrosion rate in Ca2+-containing HBSS. The results indicate that in Ca2+-containing HBSS, the formation of a partially protective Ca/P layer decelerates the corrosion progress, whereas the Fe- and Mn-phosphates formed in Ca2+-free HBSS do not have the same effect. The Ca/P layer on (Fe35Mn)5Ag experienced a reduction in resistance following several hours of testing, indicating partial loss of its protective effect.

Biodegradation behaviour of Fe-based alloys in Hanks’ Balanced Salt Solutions: Part II. The evolution of local pH and dissolved oxygen concentration at metal interface

Commercially pure Fe, Fe35Mn, and (Fe35Mn)5Ag alloys were prepared by uniaxial pressing of the mixture of individual powders, followed by sintering. The influence of the alloying elements Mn and Ag on the corrosion behaviour of these Fe-based alloys was investigated in Hanks’ Balanced Salt Solution (HBSS). Furthermore, the role of the components in HBSS, particularly Ca2+ ions during alloys degradation was studied. Distribution of local pH and dissolved oxygen concentration was measured 50 μm above the interface of the degrading alloys. The results revealed that 5 wt% Ag addition to Fe35Mn alloy triggered micro-galvanic corrosion, while uniform corrosion dominated in pure Fe and Fe35Mn. Fast precipitation of Ca–P-containing products on the surface of these Fe-based alloys buffered local pH at the metal interface, and blocked oxygen diffusion at the initial stages of immersion. In the (Fe35Mn)5Ag, the detachment or structural changes of Ca–P-containing products gradually diminished their barrier property. These findings provided valuable insights into the degradation mechanism of promising biodegradable Fe-based alloys.

Perioperative infusion therapy

Perioperative infusion support of surgical patients is the main and non-alternative element of treatment.&#x0D; At the same time, the tactics of infusion therapy continues to be the subject of study. Ideas about the optimal quantitative and qualitative composition of the fluid transfused to patients are being revised as ideas about the pathogenesis of critical conditions evolve. The basis of pathogenetic analysis of compensatory hemodynamic capabilities, as a point of application of infusion treatment, previously consisted mainly of invasive monitoring techniques, replaced in recent years by the control of routine parameters with proven high correlation with invasive ones. In current studies devoted to the problems of infusion correction of hemodynamic abnormalities, the most discussed issues are the applicability of isotonic and balanced polyionic crystalloids, less often colloidal solutions in various clinical situations, and the results of such studies do not always allow to unambiguously determine the choice of infusion media, and sometimes simply incomparable. Some researchers advocate the use of isotonic crystalloids, some works prove the best effectiveness of balanced salt solutions. With the volumes of treatment corresponding to the perioperative period, in most studies there are no differences in the effectiveness of the main composite groups of crystalloids at all. We see the reason for this in the peculiarities of randomization methods, when statistical limitations do not allow us to avoid discrete data analysis: their comparative grouping occurs according to the principle of selecting a target parameter, and all the others are classified as auxiliary or secondary. It seems to us that the involvement of arrays of data obtained in real clinical practice as a result of a combination of local theoretical and empirical ideas about corrective treatment regimens correlated with their effectiveness could smooth out the inconsistency of the results of such studies, especially since clinicians have a sample with a volemic load at their disposal, allowing them to predict the hemodynamic reaction of the patient's body to infusion and a set of routine parameters for more fine-tuning of therapy.&#x0D; In anesthesiological and resuscitation practice, there is an opinion of the currently popular empirical-evidence plan that balanced salt solutions are preferable to isotonic solutions with a higher degree of severity of patients, but this opinion is not a priori and requires additional research to verify the choice.

Phenytoin Sodium and Acetate-Maleate Buffered Balanced Salt Solutions are Physically Incompatible!

How to cite this article: Mahajan C, Singh BP, Kapoor I, Prabhakar H. Phenytoin Sodium and Acetate–Maleate Buffered Balanced Salt Solutions are Physically Incompatible! Indian J Crit Care Med 2021;25(3):352.

Intravenous Fluid Management in Critically Ill Adults: A Review.

This article reviews the management of intravenous fluids and the evaluation of volume status in critically ill adults. Intravenous fluid administration is one of the most common interventions in the intensive care unit. Critically ill patients have dynamic fluid requirements, making the management of fluid therapy challenging. New literature suggests that balanced salt solutions may be preferred in some patient populations. The bedside critical care nurse must understand the properties of various intravenous fluids and their corresponding impact on human physiology. The nurse's clinical and laboratory assessments of each patient help define the goals of fluid therapy, which will in turn be used to determine the optimal patient-specific selection and dose of fluid for administration. Nurses serve a vital role in monitoring the safety and efficacy of intravenous fluid therapy. Although this intervention can be lifesaving, inappropriate use of fluids has the potential to yield detrimental effects. This article discusses fluid physiology and the goals of intravenous fluid therapy, compares the types of intravenous fluids (isotonic crystalloids, including 0.9% sodium chloride and balanced salt solutions; hypotonic and hypertonic crystalloids; and colloids) and their adverse effects and impact on hemodynamics, and describes the critical care nurse's essential role in selecting and monitoring intravenous fluid therapy.

Comparison of Commercially Available Balanced Salt Solution and Ringer's Lactate on Extent of Correction of Metabolic Acidosis in Critically Ill Patients.

IntroductionAppropriate early fluid resuscitation is ubiquitous for critically ill patients with metabolic acidosis. Owing to harmful effects of normal saline, commercially prepared balanced salt solutions are being used. However, there is no study comparing use of Ringer's lactate (RL) and commercially available balanced salt solutions in critically ill patients.Materials and methodsA randomized controlled trial was conducted during July 2016 to December 2017. Fifty adult patients admitted to intensive care unit with metabolic acidosis were randomized into group RL or group acetate solution (AC). Respective trial fluid was administered at 20 mL/kg/hour for first hour and 10 mL/kg/hour for second hour. Arterial blood gas analysis samples were taken 15 minutes apart. The fluid resuscitation was continued till pH got corrected to 7.3 or 2 hours, whichever was earlier. The primary aim was to compare time to correct metabolic acidosis in both the groups. The secondary outcomes were the extent of correction of metabolic acidosis, total volume of fluid used, and total cost per patient.ResultsDemographic parameters, APACHE II score, and baseline investigations were comparable. The metabolic acidosis got corrected in 12 patients in group AC and 10 patients in group RL (p value = 0.66). The mean time for correction of metabolic acidosis was 57 ± 3.85 minutes in group RL and 56.25 ± 4.22 minutes in group AC (p value =0.95). The extent of correction of metabolic acidosis and total volume of fluid used was also comparable (p value = 0.05). However, the cost of fluid used was significantly higher in group AC (p value < 0.01).ConclusionDuring administration of balanced salt solutions, RL or AC, in critically ill patients with metabolic acidosis, AC did not confer any advantage in time to or extent of correction of metabolic acidosis.Clinical significanceThere is no difference in acid–base status with use of different types of balanced salt solutions for resuscitation in critically ill patients.How to cite this articleRawat N, Sahni N, Yaddanapudi L. Comparison of Commercially Available Balanced Salt Solution and Ringer's Lactate on Extent of Correction of Metabolic Acidosis in Critically Ill Patients. Indian J Crit Care Med 2020;24(7):539–543.

Bioinspired Thermosensitive Hydrogel as a Vitreous Substitute: Synthesis, Properties, and Progress of Animal Studies.

In many vitreal diseases, the surgeon removes the natural vitreous and replaces it with silicone oils, gases, or balanced salt solutions to fill the eyeball and hold the retina in position. However, these materials are often associated with complications and have properties that differ from natural vitreous. Herein, we report an extension of our previous work on the synthesis of a biomimetic hydrogel that is composed of thiolated gellan as an analogue of type II collagen and poly(methacrylamide-co-methacrylate-co-bis(methacryloyl)cystamine), a polyelectrolyte, as an analogue of hyaluronic acid. This thermosensitive hydrogel can be injected into the eye as a viscous solution at 45 °C. It then forms a physical gel in situ when it reaches body temperature, and later forms disulfide covalent crosslinks. In this article, we evaluated two different formulations of the biomimetic hydrogels for their physical, mechanical, and optical properties, and we determined their biocompatibility with several cell lines. Finally, we report on the progress of the four-month preclinical evaluation of our bio-inspired vitreous substitute in comparison to silicone oil or a balanced salt solution. We assessed the eyes with a slit-lamp examination, intraocular pressure measurements, electroretinography, and optical coherence tomography. Preliminary results are very encouraging for the continuing evaluation of our bio-inspired hydrogel in clinical trials.

Intravenous Fluid Prescription Practices in Critically Ill Children: A Shift in Focus from Natremia to Chloremia?

Our objective is to evaluate intravenous (IV) fluid prescription practice patterns in critically ill children in the first 72 hours of pediatric intensive care unit (PICU) admission and to evaluate the incidence and predictors of hyperchloremic metabolic acidemia (HCMA) and the association between HCMA and adverse outcomes. This retrospective cohort study was conducted in two tertiary-care Canadian PICUs. Children aged 0 to 18 years admitted to the PICU between January 2015 and January 2016 who received at least 50% of their calculated maintenance fluid requirements parenterally during the first 24 hours of admission were included. Children with known preexisting conditions associated with HCMA, such as renal tubular acidosis and gastrointestinal bicarbonate losses, were excluded. Of the 771 children screened, 543 met eligibility criteria and were included. The commonest prescribed maintenance fluid was 0.9% NaCl (72.9%) followed by lactated Ringer's solution (19.6%) and hypotonic solutions (4.6%). Balanced salt solutions (i.e., lactated Ringer's and Plasma-Lyte) were as commonly administered as unbalanced solutions (0.9% NaCl) for volume expansion (49.6 vs. 48.5%, respectively). Medications contributed to a significant proportion of total daily intake, in excess of bolus fluids. The incidence of hyperchloremia and HCMA was 94.9% (95% confidence interval [CI]: 93.2-96.9; 470/495) and 38.9% (95% CI: 34.6-43.2; 196/504), respectively. Predictors of HCMA were increasing combined bolus and maintenance 0.9% NaCl intake (odds ratio: 1.13; 95% CI: 1.04-1.23) and increasing severity of illness. HCMA was not associated with an increased risk of acute kidney injury, feeding intolerance, or PICU-acquired weakness. Isotonic fluids, specifically 0.9% NaCl, were the most commonly administered maintenance IV fluid in critically ill children. Sources of chloride load are not isolated to resuscitation fluids as previously suggested. Maintenance fluids and fluids administered with medications and IV flushes (fluid creep) are under-recognized significant sources of fluid and electrolyte intake in critically ill children. HCMA is common, and further prospective research is required to determine whether HCMA is indeed harmful in children. However, all significant sources of fluid should be accounted for in the design of future trials comparing balanced and unbalanced salt solutions.

Accuracy of pH Measurements in Blood‐Free Balanced Salt Solutions with and without Bovine Serum Albumin—with Four Devices (ABL80, i‐STAT®, pH Paper, and pH Probe)

IntroductionAccurate and precise measurements are vital in research. Discrepancies between the actual values and values measured by a device can have serious implications on the design and results of an experiment. Thus, it is critical to know what devices provide reliable values. The aim of this study was to compare four different devices commonly used to measure pH in the absence and presence of Bovine Serum Albumin (BSA).MethodsA balanced salt solution (NaCl 119 mM, NaHCO3 24 mM, Glucose 5.5 mM, CaCa2 1.6 mM, KCl 4.7 mM, MgSO4 1.17 mM, NaPO4 1.18 mM) with or without 4% BSA was bubbled with different CO2 percentages (2.5%, 3.8%, 5%, 7.5 %, 10%), 30% O2 and N2 as the balance gas using a gas mixer. After a steady state pH was reached, judged by the pH probe, four samples were taken simultaneously, and 3 replicate measurements with each of the four devices were made. The devices used in this study were the ABL 80 FLEX (RADIOMETER, blood gas analyzer), VetScan i‐STAT® 1, pH paper (Macherey‐Nagel, pH range 6.4 – 8.0) and a pH probe (OAKTON®, pH700). Measured pH values were plotted against the expected pH values for a given concentration of CO2 according to the Henderson–Hasselbalch equation (pH = pKa + log10 ([A−]/[HA]). Linear regression ± SEM was done for each device with and without BSA and the coefficient of determination and regression coefficients were calculated. The mean and difference of each measurement by device were then calculated and used to create Bland‐Altman plots (right lower corner in each panel) to assess the agreement of the measuring device with the expected pH.ResultsExcept for the pH paper, all devices showed a strong agreement with the expected pH for each CO2 percentage. The addition of BSA to the solution resulted in a trend to more acidic readings and to be even more in agreement with the expected pH for all four devices.ConclusionThe blood gas analyzer, i‐STAT®, and pH probe all proved to be suitable devices for use in measuring the pH of a balanced salt solution in the chosen pH range. The pH paper appeared to be unsuitable to measure the pH within physiological ranges. Additionally, throughout all measurements, the solutions with 4% BSA tended to provide even more accurate values than the solutions without BSA.Support or Funding InformationThis work was supported, in part, by institutional funds, NIH grant (5R01 HL123227), and a Merit Review Award (I01 BX003482) from the U.S. Department of Veterans Affairs Biomedical Laboratory R&amp;D Service. Regression lines for the measured pH with all devices compared to the expected pH and Bland‐Altman‐plotsimageRegression lines for the measured pH with all devices compared to the expected pH and Bland‐Altman‐plotsThis abstract is from the Experimental Biology 2019 Meeting. There is no full text article associated with this abstract published in The FASEB Journal.