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Intraocular irrigating solutions. A comparative study of BSS Plus and lactated Ringer's solution.

Isolated human corneas maintained normal corneal thickness and endothelial ultrastructural integrity throughout a three-to four-hour period of perfusion of BSS plus to the endothelial surface. By comparison, only one of six human corneas perfused with lactated Ringer's solution was able to maintain normal thickness and ultrastructural integrity. The other five corneas perfused with lactated Ringer's solution showed various degrees of endothelial cell breakdown and corneal swelling during three hours of perfusion. The results of these studies suggest that BSS plus is a better solution for maintenance of human corneal endothelium during long-term (one- to three-hour) surgical procedures.

Cornea

Plasma exchange with plasma protein fraction and lactated Ringer's solution using the continuous flow cell separator.

Ten patients underwent 50-70 percent plasma exchanges using the continuous flow cell separator. The exchange material consisted of Plasma Protein Fraction (PPF) and Lactated Ringer's Solution (LRS) instead of fresh frozen, modified or lyophilized plasma. No bleeding or other complications were encountered. The coagulation factor activity after exchange was above that required for hemostasis. The procedure is safe, expeditious and efficient.

Blood Proteins

[Studies on extracorporeal circulation with large volume hemodilution using lactate ringer's solution and low molecular weight dextran: alterations of acid-base balance associated with intentional hemodilution (author's transl)].

Twenty mongrel dogs, weighing between 7.5 and 13.0 kg were used to investigate the percentage limits permissible for hemodilution using a double-helical reservoir heart-lung machine which has a 1,100 ml of priming volume. In both 40 and 50 per cent groups of intentional hemodilution by 30 minute extracorporeal circulation, remarkable anemia was inevitable and recovery was extremely slow, especially in the 50 per cent dilution group. In both 40 and 50 per cent groups of intentional hemodilutions by 30 minute extracorporeal circulation, metabolic acidosis was observed. In 50 per cent group of intentional hemodilution, no improvement of metabolic acidosis was observed even after perfusion. When sodium bicarbonate was administered to 40 per cent hemodilution group, minimum alterations of acid-base balance and of serum electrolytes were observed during and after extracorporeal perfusion. When sodium bicarbonate was administered to 50 per cent hemodilution group, metabolic acidosis was more evident than in 40 per cent hemodilution group accompanied with an increase in serum sodium concentration and a decrease in serum chloride concentration. These data qualify the use of 40 per cent intentional hemodilution using Lactate Ringer's solution or low molecular weight dextran for 30 minute extracorporeal circulation when sodium bicarbonate is administered in adequate amounts.

Acid-Base Equilibrium

Hemodynamic and metabolic consequences of hemodilution with different diluents.

Hemodilution was performed with the crystalloid Ringer's lactate (n = 6) and the colloid Haemaccel (n = 5) in dogs during automatically controlled total cardiopulmonary bypass with constant arterial and venous pressures. Single observations were made with Macrodex and Rheomacrodex hemodilution. Hemoglobin concentration and hematocrit were used as parameters for hemodilution. Total plasma protein proved to be unsuitable. The volume needed to induce the same level of hemodilution with lactated Ringer's and Haemaccel was twice the volume needed with Macrodex and Rheomacrodex. The volume shift from intravascular to extravascular was larger during Ringer's lactate hemodilution than during Haemaccel hemodilution. The amount of volume shift was clearly related to changes in colloid osmotic pressure. Lowering of total peripheral vascular resistance, with increased arterial line flow during controlled constant arterial and venous pressures was seen during hemodilution with each of the above materials. Potassium and calcium concentrations in the blood increased significantly during hemodilution with Haemaccel. Base excess was constant during hemodilution with lactated Ringer's but decreased in all other cases. A decrease in oxygen consumption was common, and most pronounced during hemodilution with Haemaccel.

Animals

Intropin (dopamine hydrochloride) intravenous admixture compatibility. Part 1: stability with common intravenous fluids.

The stability of dopamine hydrochloride (Intropin) in several large-volume parenteral solutions was studied. Admixtures of dopamine were assayed by colorimetric and chromatographic procedures. Admixtures (800 mug dopamine per ml) in the following intravenous fluids in glass bottles at pH 6.85 or below were found to be chemically and physically stable for at least 48 hours at room temperature: dextrose 5%, dextrose 5% and sodium chloride 0.9%, 5% dextrose in 0.45% sodium chloride, dextrose 5% in lactated Ringer's solution, lactated Ringer's injection, 0.9% sodium chloride, 1/6 molar sodium lactate, and 20% mannitol. The admixture of dopamine in 5% dextrose was stable for a minimum of seven days at 5 C. A 5% dextrose-dopamine admixture in a polyvinylchloride bag was stable for at least 24 hours at room temperature. The admixture of dopamine in 5% sodium bicarbonate solution produced an unstable solution of pH 8.20. A chemical and physical change (development of a pink color) was observed in this admixture. It is recommended that dopamine not be added to 5% sodium bicarbonate solution or any alkaline intravenous solution.

Chemical Phenomena

Massive Ringer's lactate infusion: comparison with dextrose 5% and whole blood.

The objectives of this study were to compare in dogs the effects of massive infusion of Ringer's lactate, 5% dextrose in water, and whole blood. Special interest centered upon lung function, central venous pressure, and dilutional effects upon the blood components. Three groups of 5 healthy dogs each received respectively Ringer's lactate, 5% dextrose, or whole blood over 60 minutes in the amount of 135 ml/kg. Arterial blood gases and pH, right atrial and systemic arterial pressures, hemoglobin and hematocrit values, and plasma sodium, chloride, potassium and protein levels were determined. Coagulograms and serum osmolality were examined in the early experiments. The purpose of the whole blood infusion was primarily to serve for comparison in the study of dilutional effects upon blood components. There was no statistically significant change in the arterial blood gas values or pH following Ringer's lactate infusion. The infusion of 5% dextrose in water produced moderate decline in arterial Pco2 and a temporary, slight fall in blood pH. Ringer's lactate infusion produced a prompt and statistically significant rise in central venous pressure. The infusion of 5% dextrose was followed by a late moderate decline in arterial blood pressure, possibly due to marked dilution of plasma sodium, chloride and potassium. It is concluded that massive Ringer's lactate infusion is capable of increasing right atrial pressure and presumably cardiac output. In healthy dogs, lung function was not impaired sufficiently to alter arterial blood gas values. However, where other previous or concomitant factors have diminished pulmonary reserve, fluid overload may impose a serious additional burden upon cardiopulmonary function.

Aged

Compatibility and stability of diazepam injection following dilution with intravenous fluids.

The compatibility and stability of diazepam injection were studied following dilution to 10 different concentrations in dextrose 5% in water, normal saline, Ringer's injection and lactated Ringer's injection. Prepared solutions were examined for clarity and pH throughout a 24-hour period. Clear solutions were filtered and then assayed 24 hours after preparation using UV spectrophotometry. Solutions which formed visible precipitates before 24 hours or which did not demonstrate acceptable potency (greater than or equal to 90%) were assayed after shorter time periods. Dilutions lower than 1:20 (5 mg in 20 ml) resulted in immediate visible precipitates in all four diluents. The 1:20 dilution was compatible with all four diluents and maintained acceptable potency for four hours, whereas at 1:40 dilution (5 mg in 40 ml) diazepam was stable for at least 6-8 hours in the same diluents. At higher dilutions of 1:50, 1:75 and 1:100 (5 mg in 50, 75 and 100 ml, respectively) the injection was compatible with and stable in all four diluents for 24 hours. Further studies are required before the use of diazepam injection as an infusion can be recommended. However, if in some circumstances it is necessary to administer diazepam as an infusion, it is recommended that it be diluted in dextrose 5% in water, normal saline, Ringer's injection or lactated Ringer's injection to a dilution of at least 1:40 and used within 6 hours or to a dilution of 1:50 and used within 24 hours.

Diazepam

Water intoxication associated with oxytocin administration during saline-induced abortion.

Four cases of water intoxication in connection with oxytocin administration during saline-induced abortions are described. The mechanism of water intoxication is discussed in regard to these cases. Oxytocin administration during midtrimester-induced abortions is advocated only if it can be carried out under careful observations of an alert nursing staff, aware of the symptoms of water intoxication and instructed to watch the diuresis and report such early signs of the syndrome as asthenia, muscular irritability, or headaches. The oxytocin should be given only in Ringers lactate or, alternately, in Ringers lactate and a 5 per cent dextrose and water solutions. The urinary output should be monitored and the oxytocin administration discontinued and the serum electrolytes checked if the urinary output decreases. The oxytocin should not be administered in excess of 36 hours. If the patient has not aborted by then the oxytocin should be discontinued for 10 to 12 hours in order to perform electrolyte determinations and correct any electrolyte imbalance.

Abortion, Induced

Solubility of injectable Valium in intravenous solutions.

A study of the solubility of Valium in commonly used intravenous solutions showed Valium to be equally insoluble in 5% dextrose in normal saline, 5% dextrose in water, normal saline, and Ringer's lactate. However, the precipitate which was formed became completely resuspended when mixed with as little as 39-42% plasma in vitro. This would indicate that the chalky precipitate seen in the I. V. tubing when Valium is injected into a running I. V. near the venipuncture site becomes resuspended when mixed with plasma in vivo. If one elects to inject Valium into the tubing of a running I. V., it is recommended that the drug be administered slowly to assure adequate mixing with blood plasma in order to prevent the circulation of particulate matter.Valium is currently one of the most popular drugs used in the psychosedative management of the apprehensive dental patient. Various techniques are advocated for its administration from direct injection into a vein to injection of the drug into a running I. V. However, the manufacturer states that the drug should not be added to I. V. fluids or other solutions or drugs. Presumably this is because of the formation of a cloudy precipitate immediately upon addition to aqueous solutions. Grower et al. have shown that saturated aqueous solutions of Valium in normal saline redissolve when added to plasma; however, they presented no data on the behavior of solutions of Valium added to other commonly used intravenous fluids. The present study was, therefore, undertaken to study the behavior of Valium when added to lactated Ringer's solution, 5% dextrose solutions, and normal saline; and to see how human blood plasma affects the solubility of Valium in these solutions.

Diazepam

Stability of frozen solutions of cefazolin sodium.

The stability of frozen solutions of cefazolin sodium was investigated in nine commonly used diluents at concentrations of 1 g with 2.5 ml, 500 mg with 100 ml and 10 g with 45 ml in both glass and polyvinylchloride plastic containers. The diluents were: Water for Injection USP; 0.9% Sodium Chloride Injection USP; 5% Dextrose Injection USP (D5W); D5W with 0.02% sodium bicarbonate; D5W in Lactated Ringer's Injection USP; Lactated Ringer's Injection USP; Ionosol B in D5W; Normasol M in D5W; and Plasmalyte in D5W. Frozen cefazolin sodium solutions, containing Water for Injection USP, 5% Dextrose Inection USP or 0.9% Sodium Chloride Injection USP as the diluents, retained more than 90% of labeled potency for up to 26 weeks when frozen within one hour after reconstitution and held at -10 C or -20 C. Frozen cefazolin sodium solutions, made with other diluents, were stable for up to four weeks when frozen within one hour after reconstitution and held at -10 C.

Animals

Hemorrhagic shock in dogs. Comparison of treatment with shed blood alone versus shed blood plus Ringer's lactate: intravascular pressures, cardiac output, oxygen consumption, arteriovenous oxygen differences, extracellular fluid PO2, electrolyte changes, and survival rates.

The purpose of our study of hemorrhagic shock in dogs was to examine the efficacy of adding Ringer's lactate to shed blood replacement in increasing animal rates. The standard Wiggers' hemorrhagic shock technic was used in two groups of ten animals each. Intravascular pressures, cardiac outut, oxygen consumption, arteriovenous oxygen differences, extracellular fluid PO2 and pH, electrolyte changes, and survival rates were determined. There was a positive correlation between changes in cardiac output, central venous oxygen content, and PO2 and extracellular fluid PO2 as measured using subcutaneously implanted Silastic tubing and perforated plastic balls. Four of the dogs that received shed blood alone survived, whereas five of the dogs that received shed blood plus Ringer's lactate survived. This difference was not statistically significant.

Animals

Extravascular lung water accumulation in patients following coronary artery surgery.

We studied patients undergoing A-C Bypass with haemodilution. The bubble oxygenator was primed with either two units of plasma and lactated Ringer's solution (PLASMA) or with lactated Ringer's solution (RINGER'S) alone. We found no difference in pulmonary function or lung water determinations between the Ringer's and the Plasma groups. When all patients were grouped together we found no significant increase in lung water (ETVL)5 immediately post-operatively. This suggests lung water did not increase during cardiopulmonary bypass. By the following morning there was a highly significant increase in lung water which was related to changes in the balance between hydrostatic pressure and colloid osmotic pressure and which continued through the second post-operative day. Pulmonary dysfunction, as measured by gas exchange, was not a major problem except in one patient whose lung water increase exceeded 3 ml H2O/kg of total body weight (52 per cent increase) and in whom there was increased shunting. We consider the increase in lung water important, since it may reduce lung compliance and further lung water accumulation. Since the increased lung water was associated with a change in the balance of Starling's forces (PMV - COPMV), treatment designed to reduce that balance should reduce lung water accumulation.

Adult

Acetate- Versus Lactate-Buffered Crystalloids for Prevention of Post-ERCP Pancreatitis in Patients Without Access to Rectal NSAIDs: A Multicentre Double-Blind Randomized Trial.

BACKGROUND: Aggressive peri-procedural intravenous fluid (IVF) therapy with lactated Ringer's solution (LR) reduces the risk of post-ERCP pancreatitis (PEP), but the standard 8-h protocol is impractical in outpatient settings and the optimal fluid type remains uncertain. We compared LR with an acetate-buffered balanced crystalloid (AC) using a symptom-guided 4-h aggressive IVF protocol. METHODS: This multicentre, double-blind, randomized superiority trial was conducted at three academic hospitals in Korea where rectal NSAIDs are unavailable. Adults with native papillae and moderate-to-high PEP risk were randomized to receive LR or AC. The IVF protocol comprised 10 mL/kg boluses before and after ERCP, followed by 3 mL/kg/h for 4 hours and extended to 8 hours if abdominal pain developed or worsened. The primary outcome was PEP incidence; secondary outcomes included early post-ERCP pain and adverse events. RESULTS: Of 813 patients (404 LR, 409 AC), PEP occurred in 12.4% of the LR group and 11.5% of the AC group (relative risk [RR] 0.93; 95% CI, 0.64-1.35; P = 0.70). Rates of mild (7.9% vs. 7.1%) and moderate (4.5% vs. 4.4%) PEP were similar, and no severe PEP or fluid overload occurred. Among the 68.3% of patients who remained asymptomatic at 4 hours and required only 4-h IVF, PEP occurred in 7.4%, with no cases of severe PEP. CONCLUSION: In this superiority trial, acetate-buffered crystalloid did not reduce PEP compared with lactated Ringer's solution, and no significant safety differences were observed between the two agents. Lactated Ringer's remains the recommended first-line crystalloid for aggressive hydration when rectal NSAIDs are unavailable. TRIAL REGISTRATION: ClinicalTrials.gov (NCT05832047).

Humans

Comparison of cardiorespiratory effects of crystalline hemoglobin, whole blood, albumin, and Ringer's lactate in the resuscitation of hemorrhagic shock in dogs.

We studied the time course and interactions of hemodynamic, oxygen transport, colloid osmotic pressure (COP), and blood volume responses to 500 ml of crystalline hemoglobin (Hgb), 500 ml of whole blood (WB), 1,000 ml of Ringer's lactate (RL), and 500 ml of plasma protein fraction (PPF) given in random order to 12 mongrel dogs subjected to hemorrhagic shock by the standard Wiggers' technique. In general, hemodynamic and oxygen transport responses were greater and more prolonged after the colloids than after RL. These responses were related to concomitant improvement in blood volume and COP. Of the colloids, Hgb appeared to produce somewhat greater hemodynamic and oxygen transport changes. This was particularly evidenced by comparison of these responses when each fluid was the first agent used after the hemorrhage. By virtue of its capacity to increase COP and plasma volume and to carry oxygen, Hgb improved both the gross circulation and the tissue perfusion, as indicated by cardiovascular hemodynamics and bulk oxygen transport variables.

Animals

Sepsis in the baboon: factors affecting resuscitation and pulmonary edema in animals resuscitated with Ringer's lactate versus Plasmanate.

Septic shock and the formation of pulmonary edema were studied in 19 baboons. Four animals served as controls. Four were subjected to deep septic shock by infusion of live E. coli and then deliberately killed while in deep shock. Four were subjected to septic shock, resuscitated with Ringer's lactate (RL), and then killed 11/2 hours after resuscitation was started. Seven were subjected to shock and resuscitation attempted with Plasmanate (PL). Resuscitation with RL was successful for 11/2 hours in all four RL-animals. Resuscitation with PL was successful for 11/2 hours in three of the 7 PL-animals. There was an increased tendency for albumin to extravasate into the interstitium of the lungs after resuscitation. The amount of pulmonary edema, measured by both the thermodye technique and by analysis of post-mortem lung composition, was the same in animals resuscitated with RL and PL. Administration of pure colloid offers no protection to the lungs in resuscitating patients from septic shock.

Animals