Original

Intensive Care Medicine

, Volume 36, Issue 7, pp 1213-1220

First online:

Open Access This content is freely available online to anyone, anywhere at any time.

Infusion fluids contain harmful glucose degradation products

  • Anna BrylandAffiliated withDepartment of Nephrology, Lund University
  • , Marcus BromanAffiliated withDepartment of Anaesthesiology and Intensive Care, Lund University Hospital
  • , Martin ErixonAffiliated withDepartment of Analytical Chemistry, Lund University
  • , Bengt KlarinAffiliated withDepartment of Anaesthesiology and Intensive Care, Lund University Hospital
  • , Torbjörn LindénAffiliated withGambro Lundia AB
  • , Hans FribergAffiliated withDepartment of Anaesthesiology and Intensive Care, Lund University Hospital
  • , Anders WieslanderAffiliated withGambro Lundia AB
  • , Per KjellstrandAffiliated withGambro Lundia AB
  • , Claudio RoncoAffiliated withDepartment of Nephrology, St. Bortolo Hospital
    • , Ola CarlssonAffiliated withGambro Lundia AB
    • , Gabriela GodalyAffiliated withDepartment of Microbiology, Immunology and Glycobiology, Lund University Email author 

Abstract

Purpose

Glucose degradation products (GDPs) are precursors of advanced glycation end products (AGEs) that cause cellular damage and inflammation. We examined the content of GDPs in commercially available glucose-containing infusion fluids and investigated whether GDPs are found in patients’ blood.

Methods

The content of GDPs was examined in infusion fluids by high-performance liquid chromatography (HPLC) analysis. To investigate whether GDPs also are found in patients, we included 11 patients who received glucose fluids (standard group) during and after their surgery and 11 control patients receiving buffered saline (control group). Blood samples were analyzed for GDP content and carboxymethyllysine (CML), as a measure of AGE formation. The influence of heat-sterilized fluids on cell viability and cell function upon infection was investigated.

Results

All investigated fluids contained high concentrations of GDPs, such as 3-deoxyglucosone (3-DG). Serum concentration of 3-DG increased rapidly by a factor of eight in patients receiving standard therapy. Serum CML levels increased significantly and showed linear correlation with the amount of infused 3-DG. There was no increase in serum 3-DG or CML concentrations in the control group. The concentration of GDPs in most of the tested fluids damaged neutrophils, reducing their cytokine secretion, and inhibited microbial killing.

Conclusions

These findings indicate that normal standard fluid therapy involves unwanted infusion of GDPs. Reduction of the content of GDPs in commonly used infusion fluids may improve cell function, and possibly also organ function, in intensive-care patients.

Keywords

Glucose Infusion fluids Toxicity Advanced glycation end products Neutrophils Innate defense Cell survival