Volume kinetics of Ringer solution after surgery for hip fracture

Reports of Investigation

Abstract

Purpose

To study the time course of volume changes during and after infusion of Ringer’s solution in elderly patients after a standardised trauma.

Methods

The kinetics of 12.5 ml·kg−1 Ringer’s solution infused over 30 min were studied in ten patients one day after surgery for hip fracture (mean age, 70 yr) and in an age- and sex-matched control group. Hemodilution, as measured every five minutes for 90 min, was used to calculate the size of the fluid space expanded by the fluid(V) and the elimination rate constant (kr). The baseline fluid balance status in the patients and the controls was compared by bioelectrical impedance analysis.

Results

The size of Vwas 4.1 ± 0.51 (mean ± SEM) in the patients and 3.4 ± 0.21 in the controls (P:NS) while the corresponding results forkr were 85 ± 12 and 166 ± 27 ml·min−1, respectively (P < 0.04). Bioelectrical impedance analysis showed that the extracellular fluid space and the total body water volumes did not differ between the two groups. Computer simulations based on the data obtained forV andkr indicate that trauma increases the dilution of the plasma volume and the retention of fluid in response to slow and moderate infusion rates, while these indices of short-term changes in fluid balance remain the same in the two groups during very rapid infusion of Ringer’s solution.

Conclusion

A slower elimination rate increased dilution of plasma and retention of fluid when Ringer’s solution was infused in elderly trauma patients.

Résumé

Objectif

Examiner l’évolution des changements de volume pendant et après une perfusion de liquide de Ringer chez des patients âgés qui ont subi un trauma comparable.

Méthode

Un jour après une chirurgie de la hanche, la cinétique de 12,5 ml·kg−1de liquide de Ringer, perfusé pendant 30 min, a été étudiée chez dix patients (âge moyen de 70 ans) et chez des patients témoins appariés selon l’âge et le sexe. Lhémodilution, par des mesures faites toutes les cinq minutes pendant 90 min, a servi au calcul du volume du compartiment liquidien, expansé par le fluide (V), et de la constante de vitesse d’élimination(ke). Le bilan hydrique initial des patients a été comparé à celui des témoins par une analyse de l’impédance bioélectrique.

Résultats

La valeur de V a été de 4,1 ± 0,51 (moyenne ± l’erreur type) chez les patients et de 3,4 ± 0,21 chez les témoins (P: NS) et les résultats correspondants pourke ont été de 85 ± 12 et de 166 ± 27 ml·min−1, respectivement (P < 0,04). Suivant l’analyse de l’impédance bioélectrique, le compartiment extracellulaire et le volume d’eau total de l’organisme n’affichaient pas de différence intergroupe. Des simulations sur ordinateur à partir des valeurs observées deV et deke ont indiqué que le trauma augmente la dilution du volume plasmatique et la rétention de liquide lors d’une perfusion lente et modérée, mais que ces indices de changement de courte durée du bilan hydrique demeurent les mêmes dans les deux groupes pendant une perfusion très rapide de liquide de Ringer.

Conclusion

Une vitesse d’élimination plus lente augmente la dilution du plasma et la rétention de liquide lors d’une perfusion de liquide de Ringer chez des patients âgés victimes de trauma.

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Copyright information

© Canadian Anesthesiologists 1999

Authors and Affiliations

  • Christer Svensén
    • 1
  • Sari Ponzer
    • 1
  • Robert G. Hahn
    • 1
  1. 1.Departments of Anaesthesia and OrthopaedicsSöder HospitalStockholmSweden

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