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The impact of lactate-buffered high-volume hemofiltration on acid-base balance

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Abstract

Objective

To evaluate the effect of high-volume hemofiltration (HVHF) with lactate-buffered replacement fluids on acid-base balance.

Design

Randomized crossover study.

Setting

Intensive Care Unit of Tertiary Medical Center

Participants

Ten patients with septic shock and acute renal failure.

Interventions

Random allocation to 8 h of isovolemic high-volume hemofiltration (ultrafiltration rate: 6 l/h) or 8 h of isovolemic continuous venovenous hemofiltration (ultrafiltration rate: 1 l/h) with lactate-buffered replacement fluid with subsequent crossover.

Measurements and results

We measured blood gases, electrolytes, albumin, and lactate concentrations and completed quantitative biophysical analysis of acid-base balance changes. Before high-volume hemofiltration, patients had a slight metabolic alkalosis [pH: 7.42; base excess (BE) 2.4 mEq/l] despite hyperlactatemia (lactate: 2.51 mmol/l). After 2 h of high-volume hemofiltration, the mean lactate concentration increased to 7.30 mmol/l (p=0.0001). However, a decrease in chloride, strong ion difference effective, and strong ion gap (SIG) compensated for the effect of iatrogenic hyperlactatemia so that the pH only decreased to 7.39 (p=0.05) and the BE to −0.15 (p=0.001). After 6 h, despite persistent hyperlactatemia (7 mmol/l), the pH had returned to 7.42 and the BE to 2.45 mEq/l. These changes remained essentially stable at 8 h. Similar but less intense changes occurred during continuous venovenous hemofiltration.

Conclusions

HVHF with lactate-buffered replacement fluids induces iatrogenic hyperlactatemia. However, such hyperlactatemia only has a mild and transient acidifying effect. A decrease in chloride and strong ion difference effective and the removal of unmeasured anions all rapidly compensate for this effect.

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Authors and Affiliations

  1. Department of Intensive Care, Austin and Repatriation Medical Centre, Studley Road, 3084, Heidelberg, Victoria, Australia

    Louise Cole, Rinaldo Bellomo, Ian Baldwin & Matthew Hayhoe

  2. Divisione di Nefrologia, Ospedale San Bortolo, Vicenza, Italy

    Claudio Ronco

Authors
  1. Louise Cole
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  2. Rinaldo Bellomo
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  3. Ian Baldwin
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  4. Matthew Hayhoe
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  5. Claudio Ronco
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Corresponding author

Correspondence to Rinaldo Bellomo.

Additional information

This study was supported by the Austin Hospital Anaesthesia and Intensive Care Trust Fund (Melbourne, Australia), the Laerdal Foundation (Stavanger, Norway) and Hospal Pty. Ltd. (Lyon, France).

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Cole, L., Bellomo, R., Baldwin, I. et al. The impact of lactate-buffered high-volume hemofiltration on acid-base balance. Intensive Care Med 29, 1113–1120 (2003). https://doi.org/10.1007/s00134-003-1812-1

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  • DOI: https://doi.org/10.1007/s00134-003-1812-1

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