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Solutés balancés en réanimation

Crystalloid fluids in intensive care unit

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Réanimation

Résumé

Les solutés cristalloïdes représentent souvent la première étape thérapeutique de la prise en charge des états de choc hypovolémique vrai ou relatif. Cependant, leur administration expose à des effets secondaires. L’administration de sérum salé à 0,9 % présente une charge chlorée potentiellement pourvoyeuse d’une acidose hyperchlorémique, dont l’impact clinique reste peu exploré, mais qui pourrait être responsable de défaillances d’organes, principalement rénales et plaquettaires, augmenterait l’inflammation et ainsi potentiellement la morbimortalité. Les solutés balancés présentent une charge chlorée réduite, grâce à l’adjonction d’un anion organique (malate, acétate, lactate…), permettant, selon le principe physicochimique de Stewart, de limiter la survenue d’une acidose hyperchlorémique.

Abstract

Crystalloid fluids are often used to treat patients in the early stages of shock with true or relative hypovolemia. Nevertheless, their infusion could be associated with side effects. Indeed, 0.9% saline includes a high concentration of chloride ion sometimes responsible for hyperchloremic acidosis. Its clinical impact is uncertain but could be responsible for organ dysfunction, mainly renal and coagulopathy, could induce a rise in inflammatory process and thus could worsen morbidity and mortality. The addition of an organic anion in balanced solutions allows a reduced chloride concentration which, according to Stewart theory, limits the occurrence of hyperchloremic acidosis.

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Authors and Affiliations

  1. Service de réanimation médicale, CHU Charles-Nicolle, 1, rue de Germont, F-76031, Rouen cedex, France

    E. Besnier, S. Grange & F. Tamion

  2. Inserm U1096, FHU, Faculté de médecine-pharmacie, université de Rouen, F-76031, Rouen cedex, France

    E. Besnier & F. Tamion

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  1. E. Besnier
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  2. S. Grange
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Correspondence to E. Besnier.

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Besnier, E., Grange, S. & Tamion, F. Solutés balancés en réanimation. Réanimation 25, 212–220 (2016). https://doi.org/10.1007/s13546-016-1171-x

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