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Chinese Journal of Clinical Pharmacology and Therapeutics ›› 2019, Vol. 24 ›› Issue (4): 424-432.doi: 10.12092/j.issn.1009-2501.2019.04.010

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Volume kinetics of Ringer's lactate in acute inflammatory disease

YE Xiaomin 1, YI Shenghua 2,3, ZHU Yeke 2,3, CHAN Yue 2,3, TENG Yitong 2,3, TENG Wenbin 2,3, LI Yuhong 2,3   

  1. 1 Department of Anesthesiology, the First Wenlin People's Hospital, Wenlin 317500, Zhejiang, China; 2 Medical Research Center, 3 Department of Anesthesiology, Shaoxing People's Hospital, Shaoxing 312000, Zhejiang, China; 4 Kunming University of Science and Technology, School of Medicine, Kunming 690093, Guangxi, China
  • Received:2018-08-19 Revised:2019-03-24 Online:2019-04-26 Published:2019-05-01

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Abstract:

AIM: To explore the volume kinetics of Ringer's lactate (RL) in acute inflammatory disease and whether the inflammatory biomarker would be associated with altered distribution and elimination of RL. METHODS: In this prospective cohort study, we enrolled 40 ASA physical status I-II patients undergoing elective laparoscopic cholecystectomy (cholecystitis group, n=20) or emergency laparoscopic appendectomy (appendicitis group, n=20). All of the patients were infused RL (15 mL/kg) intravenously over 35 min, starting before the induction of general anesthesia. Plasma concentrations of inflammatory (tumor necrosis factor-α, interleukin-10, and C-reactive protein) and endothelial damage (syndecan-1, SDC-1) biomarkers were quantified by enzyme-linked immunosorbent assay (ELISA). The kinetics of RL and the effects of covariates were calculated by plasma dilution based on the dilution of hemoglobin-time curve, urinary excretion by using Phoenix software for mixed effects modeling. RESULTS:Compared with the cholecystitis group, the rate constant for fluid transfer from the peripheral fluid space to the central fluid space (k21) decreased significantly in the appendicitis group (14×10-3min-1 versus 35×10-3min-1; P=0.012), in whom higher plasma concentrations of C-reactive protein (CRP) were measured ［median: 38.1(1.8-143.6) μg/mL versus 1.3(0.1-159.0) μg/mL, P<0.001］. Compared with conscious period, ongoing anesthesia (duration: 30 min-45 min after beginning of infusion) increased the rate constant for fluid transfer from the plasma to the extravascular space (k12) significantly (57×10-3min-1 versus 32×10-3min-1), and decreased the elimination rate constant (k10: from 0.6×10-3min-1 to 5.3×10-3min-1; P<0.001). A lower mean arterial pressure was associated with reduced elimination, independent of conscious/anaesthetized state. However, no biomarkers for inflammation or endothelial damage were significantly associated covariates in the kinetic model. CONCLUSION: No association was found between the volume kinetics of Ringer's lactate and the degree of inflammation (as indicated by established biomarkers) in patients with cholecystitis or appendicitis. However, the rate of elimination was greatly retarded by general anesthesia in both groups.

Key words: crystalloid solutions, Ringer's lactate, humans, inflammation, volume kinetics

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