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

Autor: Rudolf D; Clinic of Anesthesiology, Hannover Medical School, Hannover, Germany., Witt L; Clinic of Anesthesiology, Hannover Medical School, Hannover, Germany.; Clinic of Anesthesiology, KRH Klinikum Robert Koch, Gehrden, Germany., Boethig D; Clinic for Cardiac, Thoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover, Germany., Rigterink V; Clinic of Anesthesiology, Hannover Medical School, Hannover, Germany., Zander R; Physioklin, Mainz, Germany., Sümpelmann R; Clinic of Anesthesiology, Hannover Medical School, Hannover, Germany., Dennhardt N; Clinic of Anesthesiology, Hannover Medical School, Hannover, Germany.
Jazyk: angličtina
Zdroj: Paediatric anaesthesia [Paediatr Anaesth] 2022 Aug; Vol. 32 (8), pp. 961-966. Date of Electronic Publication: 2022 May 31.
DOI: 10.1111/pan.14494
Abstrakt: Background: 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 H 2 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.
Aim: 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.
Methods: 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.
Results: 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 H 2 O -1 ; p < .01) within a normal range.
Conclusions: 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 H 2 O -1 ) using Zander's formula.
Trial Registration: ClinicalTrials.gov (ID: NCT02495285).
(© 2022 The Authors. Pediatric Anesthesia published by John Wiley & Sons Ltd.)
Databáze: MEDLINE
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