Electrolyte-based calculation of fluid shifts after infusing 0.9% saline in severe hyperglycemia.

ABSTRACT:

Background

Early treatment of severe hyperglycemia involves large shifts of body fluids that entail a risk of hemodynamic instability. We studied the feasibility of applying a new electrolyte equation that estimates the degree of volume depletion and the distribution of infused 0.9% saline in this setting.

Methods

The new equation was applied to plasma and urinary concentrations of sodium and chloride measured before and 30?min after a 30-min infusion of 1?L of 0.9% saline on two consecutive days in 14 patients with severe hyperglycemia (mean age 50?years). The extracellular fluid (ECF) volume was also estimated based on the volume dilution kinetics of chloride.

Results

On day 1, the baseline ECF volume amounted to 11.5?L. The saline infusion expanded the ECF space by 160?mL and the intracellular fluid space by 375?mL. On day 2, the ECF volume was 15.5?L, and twice as much of the infused fluid remained in the ECF space. The chloride dilution kinetics yielded baseline ECF volumes of 11.6 and 15.2?L on day 1 and day 2, respectively. No net uptake of glucose to the cells occurred during the two 1-h measurement periods despite insulin administration in the intervening time period.

Conclusions

The electrolyte equation was feasible to apply in a group of hyperglycemic patients. The ECF space was 3?L smaller than expected on admission but normal on the second day. Almost half of the infused fluid was distributed intracellularly.

SUBMITTER: Svensson R 

PROVIDER: S-EPMC7554273 | biostudies-literature | 2020 Oct

REPOSITORIES: biostudies-literature