Isotonic saline causes greater volume overload than electrolyte-free irrigating fluids

Robert G. Hahn

doi:10.1515/jbcpp-2021-0032

Article

Isotonic saline causes greater volume overload than electrolyte-free irrigating fluids

Robert G. Hahn

Published/Copyright: September 27, 2021

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From the journal Journal of Basic and Clinical Physiology and Pharmacology Volume 34 Issue 6

Abstract

Objectives

Systemic absorption of the irrigating fluid used to flush the operating site is a potentially serious complication in several types of endoscopic operations. To increase safety, many surgeons have changed from a monopolar to a bipolar resection technique because 0.9% saline can then be used instead of electrolyte-free fluid for irrigation. The present study examines whether the tendency for excessive plasma volume expansion is greater with saline than with electrolyte-free fluid.

Methods

Pooled data were analyzed from four studies in which a mean of 1.25 L of either 0.9% saline or an electrolyte-free irrigating fluid containing glycine, mannitol, and sorbitol was given by intravenous infusion on 80 occasions to male volunteers and patients scheduled for transurethral prostatic surgery. The distribution of the infused fluid was analyzed with a population volume kinetic model based on frequently measured hemodilution and the urinary excretion.

Results

Electrolyte-free fluid distributed almost twice as fast and was excreted four times faster than 0.9% saline. The distribution half-life was 6.5 and 10.6 min for the electrolyte-free fluid and saline, respectively, and the elimination half-lives (by urinary excretion) from the plasma volume were 21 and 87 min. Simulation showed that the plasma volume expansion was twice as great from 0.9% saline than from electrolyte-free fluid.

Conclusions

Isotonic (0.9%) saline expands the plasma volume by twice as much as occurs with electrolyte-free irrigating fluids. This difference might explain why signs of cardiovascular overload are the most commonly observed adverse effects when saline is absorbed during endoscopic surgery.

Keywords: fluid overload; glycine solution; isotonicsaline; pharmacokinetics

Corresponding author: Robert G. Hahn, MD, PhD, Professor of Anaesthesia & Intensive Care, Research Unit, Södertälje Hospital, 152 86 Södertälje, Sweden; and Karolinska Institutet at Danderyds Hospital (KIDS), Stockholm, Sweden, Phone: +4673660972, E-mail: r.hahn@telia.com

Acknowledgments

The author is grateful to the co-authors and others who contributed to the original papers on which the present work is based.

Research funding: None declared.
Author contributions: The author designed and evaluated all included studies as well as the current pooled analysis. He made the calculations and wrote the manuscript.
Competing interests: The author states no conflict of interest.
Informed consent: Informed consent was obtained from all individuals included in this report.
Ethical approval: The protocols were been approved by the Regional Ethics Committee of Stockholm before enrolment was initiated (Dnr 113/89, 127/92, 54/95 and 2008/804-31/2).
Availability of data and material: The data is available online as Original data.xls.

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Received: 2021-01-25

Accepted: 2021-09-11

Published Online: 2021-09-27

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Articles in the same Issue

https://doi.org/10.1515/jbcpp-2021-0032

Keywords for this article

fluid overload; glycine solution; isotonicsaline; pharmacokinetics