Plasma-Lyte A improves acid-base status in adult trauma patients

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1. Resuscitation with Plasma-Lyte A improved base deficit and hyperchloremia in trauma patients at 24 hours compared to normal saline. 

2. Patients resuscitated with Plasma-Lyte A had normal arterial pH and magnesium levels compared to resuscitation with normal saline. 

Evidence Rating Level: 1 (Excellent) 

Study Rundown: Fluid resuscitation with normal saline encompasses high levels of sodium and chloride and can result in detrimental clinical outcomes by causing hyperchloremic metabolic acidosis, reduced renal perfusion, and immune dysfunction. Some balanced crystalloid solutions like Lactated Ringer’s solution cannot be co-administered with citrate preserved blood, as the calcium affects the anticoagulant properties of citrate. This study showed that in comparison with normal saline, resuscitation with Plasma-Lyte A improved acid base status, serum chloride, and serum magnesium levels in adult trauma patients. One of the limitations of this study was that it was underpowered, and was unable to detect statistically significant differences in urine output and delta creatinine, which would have offered insight regarding the effects of Plasma-Lyte A and normal saline on kidney function in trauma patients.

Click to read the study in Annals of Surgery

Relevant Reading: Major complications, mortality, and resource utilization after open abdominal surgery: 0.9% saline compared to Plasma-Lyte.

In-Depth [randomized controlled trial]:This double blinded, randomized controlled trial examined 46 adult patients who met triage criteria for severe trauma. Patients were randomized to receive either resuscitation with Plasma-Lyte A or 0.9% NaCl.Baseline characteristics were similar between both study groups. The primary endpoint of the study was change in the base excess within 24 hours, and was significantly improved in the Plasma-Lyte A group compared to the normal saline group (7.5 ± 4.7 vs 4.4 ± 3.9 mmol/L). Arterial pH was significantly higher in the Plasma-Lyte A group (7.41 vs 7.37), serum chloride was significantly lower (104 vs 111), and serum magnesium levels were stable without supplementation. There were no significant differences in serum potassium, calcium, or phosphate levels at 24 hours between two groups. The difference in urine output in the first 6 hours was barely statistically insignificant (1684 mL vs 997 mL, p=0.051).

By James Jiang and Allen Ho

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