Skip to main content
NCBI home page
Thorax logoLink to Thorax
. 1967 Mar;22(2):180–187. doi: 10.1136/thx.22.2.180

Biochemical changes associated with the use of haemodilution with 5% dextrose in water and mannitol for open-heart surgery

I W P Obel 1,2, P Marchand 1,2, L Du Plessis 1,2
PMCID: PMC471604  PMID: 6033386

Abstract

Many advantages are gained from the use of haemodilution in open-heart surgery. There is a lessened post-operative morbidity from bleeding, renal failure, and serum hepatitis. However, dilution with 5% dextrose in water is associated with a greater metabolic acidosis and a higher incidence of serious dysrhythmias than is pure blood. In order to elucidate the causes of these complications, 26 patients were studied using different degrees of haemodilution. The metabolic acidosis appeared to be mainly due to the dilution of blood buffer. Changes in electrolyte balance were more marked with greater dilution. The effects on serum sodium and chlorides were transient. The serum potassium level fell markedly during the post-operative phase and was associated with dysrhythmias. We believe that variation in potassium concentration is due to redistribution of potassium between the intracellular and extracellular phase as well as to an increased urinary excretion of potassium. The acidosis and hypokalaemia can be rapidly corrected by the administration of sodium bicarbonate and potassium. The changes in acid-base metabolism and electrolyte balance can possibly be prevented by suitably modifying the priming fluid.

Full text

PDF
180

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. ALLISON A. C., BLUMBERG B. S. An isoprecipitation reaction distinguishing human serum-protein types. Lancet. 1961 Mar 25;1(7178):634–637. doi: 10.1016/s0140-6736(61)91654-3. [DOI] [PubMed] [Google Scholar]
  2. ALSEVER J. B., BARGER J. D. Thymol turbidity and thymol flocculation tests as a screening technic to detect blood donors carrying the hepatitis virus. II. The results of follow up studies of six months or more on 2,385 transfused patients. Transfusion. 1961 Sep-Oct;1:295–304. doi: 10.1111/j.1537-2995.1961.tb00061.x. [DOI] [PubMed] [Google Scholar]
  3. ANDERSEN O. S., ENGEL K., JORGENSEN K., ASTRUP P. A Micro method for determination of pH, carbon dioxide tension, base excess and standard bicarbonate in capillary blood. Scand J Clin Lab Invest. 1960;12:172–176. doi: 10.3109/00365516009062419. [DOI] [PubMed] [Google Scholar]
  4. Barnard M. S., Saunders S. J., Eales L., Barnard C. N. Hypokalaemia during extracorporeal circulation. Lancet. 1966 Jan 29;1(7431):240–240. doi: 10.1016/s0140-6736(66)90057-2. [DOI] [PubMed] [Google Scholar]
  5. COOLEY D. A., BEALL A. C., Jr, GRONDIN P. Open-heart operations with disposable oxygenators, 5 per cent dextrose prime, and normothermia. Surgery. 1962 Nov;52:713–719. [PubMed] [Google Scholar]
  6. DEWALL R. A., LILLEHEI R. C., SELLERS R. D. Hemodilution perfusions for open-heart surgery. Use of five per cent dextrose in water for the priming volume. N Engl J Med. 1962 May 24;266:1078–1084. doi: 10.1056/NEJM196205242662103. [DOI] [PubMed] [Google Scholar]
  7. FLEMMA R. J., YOUNG W. G., Jr THE METABOLIC EFFECTS OF MECHANICAL VENTILATION AND RESPIRATORY ALKALOSIS IN POSTOPERATIVE PATIENTS. Surgery. 1964 Jul;56:36–43. [PubMed] [Google Scholar]
  8. FUDENBERG H., ALLEN F. H., Jr Transfusion reactions in the absence of demonstrable incompatibility. N Engl J Med. 1957 Jun 20;256(25):1180–1184. doi: 10.1056/NEJM195706202562504. [DOI] [PubMed] [Google Scholar]
  9. GADBOYS H. L., LITWAK R. S. THE POSTPERFUSION HEMATOCRIT. J Thorac Cardiovasc Surg. 1963 Dec;46:772–782. [PubMed] [Google Scholar]
  10. KAHN D. R., HIDALGO H. F., STEUDE G. M., ERICSSON J. A., LEE R. W., SLOAN H. HEMODILUTION STUDIES IN EXTRACORPOREAL CIRCULATION WITH THE USE OF A ROTATING-DISC OXYGENATOR. J Thorac Cardiovasc Surg. 1963 Dec;46:765–771. [PubMed] [Google Scholar]
  11. KOLFF W. J., EFFLER D. B., GROVES L. K. A review of four dreaded complications of open-heart operations. Causes, avoidance, and treatment of acidosis, overoxygenation, heart-block, and pulmonary damage. Br Med J. 1960 Apr 16;1(5180):1149–1153. doi: 10.1136/bmj.1.5180.1149. [DOI] [PMC free article] [PubMed] [Google Scholar]
  12. KREVANS J. R., JACKSON D. P., CONLEY C. L., HARTMANN R. C. The nature of the hemorrhagic disorder accompanying hemolytic transfusion reactions in man. Blood. 1957 Sep;12(9):834–843. [PubMed] [Google Scholar]
  13. LITWAK R. S., GILSON A. J., SLONIM R., McCUNE C. C., KIEM I., GADBOYS H. L. Alterations in blood volume during "normovolemic" total body perfusion. J Thorac Cardiovasc Surg. 1961 Oct;42:477–488. [PubMed] [Google Scholar]
  14. LOWN B., WYATT N. F., CROCKER A. T., GOODALE W. T., LEVINE S. A. Interrelationship of digitalis and potassium in auricular tachycardia with block. Am Heart J. 1953 Apr;45(4):589–601. doi: 10.1016/0002-8703(53)90169-0. [DOI] [PubMed] [Google Scholar]
  15. MACKENZIE G. J., DAVIES S. H., MASSON H. B., WADE J. D. CAUSES OF METABOLIC ACIDOSIS IN EXTRACORPOREAL CIRCULATION AT NORMOTHERMIA. Thorax. 1963 Sep;18:215–219. doi: 10.1136/thx.18.3.215. [DOI] [PMC free article] [PubMed] [Google Scholar]
  16. MARCHAND P., PLESSISL D. U., BECKERLING C., DURR M. H. EXTRACORPOREAL HYPOTHERMIA WITHOUT THORACOTOMY. AN EXPERIMENTAL STUDY IN THE USE OF COLD FOR NEUROSURGERY AND CANCERICIDAL PERFUSIONS. Br J Surg. 1964 Apr;51:305–314. doi: 10.1002/bjs.1800510410. [DOI] [PubMed] [Google Scholar]
  17. NORMAN J. C., MCDONALD H. P., SLOAN H. THE EARLY AND AGGRESSIVE TREATMENT OF ACUTE RENAL FAILURE FOLLOWING CARDIOPULMONARY BYPASS WITH CONTINUOUS PERITONEAL DIALYSIS. Surgery. 1964 Jul;56:240–248. [PubMed] [Google Scholar]
  18. SCHLOSSER V., GROTE G. BLOOD GASES AND ACID-BASE METABOLISM WITH THE USE OF BLOOD AND BLOOD SUBSTITUTES IN ARTIFICIAL CIRCULATION DURING HYPOTHERMIA. Surgery. 1964 Mar;55:440–445. [PubMed] [Google Scholar]
  19. SCHMIDT P. J., PEDEN J. C., Jr, BRECHER G., BARANOVSKY A. Thrombocytopenia and bleeding tendency after extracorporeal circulation. N Engl J Med. 1961 Dec 14;265:1181–1185. doi: 10.1056/NEJM196112142652403. [DOI] [PubMed] [Google Scholar]
  20. WINTERS R. W., SCAGLIONE P. R., NAHAS G. G., VEROSKY M. THE MECHANISM OF ACIDOSIS PRODUCED BY HYPEROSMOTIC INFUSIONS. J Clin Invest. 1964 Apr;43:647–658. doi: 10.1172/JCI104950. [DOI] [PMC free article] [PubMed] [Google Scholar]
  21. WRIGHT H. K., GANN D. S. HYPERGLYCEMIC HYPONATREMIA IN NONDIABETIC PATIENTS. Arch Intern Med. 1963 Sep;112:344–346. doi: 10.1001/archinte.1963.03860030098008. [DOI] [PubMed] [Google Scholar]
  22. YOUNG W. G., Jr, SEALY W. C., HARRIS J. S. The role of intracellular and extracellular electrolytes in the cardiac arrhythmias produced by prolonged hypercapnia. Surgery. 1954 Sep;36(3):636–649. [PubMed] [Google Scholar]
  23. ZUHDI N., CAREY J., SHELDON W., GREER A. COMPARATIVE MERITS AND RESULTS OF PRIMES OF BLOOD AND FIVE PER CENT DEXTROSE IN WATER FOR HEART-LUNG MACHINES: ANALYSIS OF 250 PATIENTS. J Thorac Cardiovasc Surg. 1964 Jan;47:66–78. [PubMed] [Google Scholar]
  24. ZUHDI N., McCOLLOUGH B., CAREY J., GREER A. Double-belical reservoir heart-lung machine designed for hypothermic perfusion; primed with 5 per cent glucose in water; inducing hemodilution. Arch Surg. 1961 Feb;82:320–325. doi: 10.1001/archsurg.1961.01300080148015. [DOI] [PubMed] [Google Scholar]

Articles from Thorax are provided here courtesy of BMJ Publishing Group

RESOURCES