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High-molecular-weight linear polymers (HMWLPs) have earned the name "drag-reducing polymers" because of their ability to reduce drag in turbulent flows. Recently, these polymers have become popular in bioengineering applications. This study investigated whether the addition of HMWLP in a venoarterial extracorporeal circulation (ECC) model could improve microvascular perfusion and oxygenation. Golden Syrian hamsters were instrumented with a dorsal skinfold window chamber and subjected to ECC using a circuit comprised of a peristaltic pump and a bubble trap. The circuit was primed with lactated Ringer solution (LR) containing either 5 ppm of polyethylene glycol (PEG) with a low molecular weight of 500 kDa (PEG500k) or 5 ppm of PEG with a high molecular weight of 3,500 kDa (PEG3500k). After 90 min of ECC at 15% of the animal's cardiac output, the results showed that the addition of PEG3500k to LR improved microvascular blood flow in arterioles and venules acutely (2 h after ECC), whereas functional capillary density showed improvement up to 24 h after ECC. Similarly, PEG3500k improved venular hemoglobin O2 saturation on the following day after ECC. The serum and various excised organs all displayed reduced inflammation with the addition of PEG3500k, and several of these organs also had a reduction in markers of damage with the HMWLPs compared to LR alone. These promising results suggest that the addition of small amounts of PEG3500k can help mitigate the loss of microcirculatory function and reduce the inflammatory response from ECC procedures.NEW & NOTEWORTHY High-molecular-weight linear polymers have gained traction in bioengineering applications. The addition of PEG3500k to lactated Ringer solution (LR) improved microvascular blood flow in arterioles and venules acutely after extracorporeal circulation (ECC) in a hamster model and improved functional capillary density up to 24 h after ECC. PEG3500k improved venular hemoglobin O2 saturation and oxygen delivery acutely after ECC and reduced inflammation in various organs compared to LR alone.

Introduction: Mannitol, an osmotic diuretic solution, is commonly utilized in priming cardiopulmonary bypass (CPB) and can impact kidney function. This study was conducted to investigate the impact of mannitol use during CPB on kidney function in patients undergoing coronary artery bypass surgery. Methods: This randomized, double-blind clinical trial studied 90 patients undergoing coronary artery bypass surgery. In the control group (n=45), the prime solution included Ringer’s lactate, and in the intervention group (n=45), the prime solution had 200 ml of mannitol 20% and Ringer’s lactate. A P-value0.05). Additionally, there was no statistically significant difference between two groups in terms of CPB time, aortic cross-clamp time, length of time connected to mechanical ventilation, 30-day mortality, ICU, and hospital stay time (P>0.05). Furthermore, no statistically significant difference was observed between the two groups in serum creatinine levels (P=0.53) or BUN levels (P=0.13). The study also found no statistically significant difference in the diuresis rate between the two groups (P=0.10). Conclusion: The present study has shown that adding mannitol to the prime has no effect on kidney function, length of time connected to mechanical ventilation, length of stay in the ICU, or 30-day mortality. Therefore, it suggests that mannitol cannot be used as a preventative strategy for acute kidney injury after cardiac surgery.

BACKGROUND Delivery by caesarean section is common in recent times and subarachnoid block is the technique of choice due to its simplicity and reliability. However, it can cause hypotension which is associated with increased morbidity and mortality. Preloading the parturient with colloid is more effective than crystalloid in preventing the hypotension. Among the commercially available colloids 6% Pentastarch in 0.9% saline has the best safety profile. In this study, we compared the efficacy of 10ml/kg Ringer’s lactate to that of 10ml/kg 6% Pentastarch in preventing the incidence and severity of hypotension in parturients undergoing LSCS under SAB. MATERIAL AND METHODS After the ethical committee's approval, a randomized study was conducted on 114 parturients (aged between 20 -32 years) and divided into two groups. Group P - 6% Pentastarch 10ml/kg IV and Group R - Ringer’s Lactate 10ml/kg IV. Study drugs were administered intravenously over 20 minutes before the performance of the subarachnoid block. HR, SBP, DBP, MAP and SPO2 were noted every minute for the first 10 minutes, thereafter for every 5 mins till the end of surgery. RESULTS The mean HR of group P was better maintained than that of group R. A statistically significant fall in SBP was seen with group R more than group P at the 2nd, 4th, 6th, 7th, 10th and 40th minute. Group P had significantly less fall in DBP and MAP than group R. CONCLUSION Our study demonstrates that 6% Pentastarch is better preloading fluid than Ringer’s lactate in preventing hypotension in parturients undergoing elective caesarean section under subarachnoid block. [ABSTRACT FROM AUTHOR]

Introduction: Mannitol, an osmotic diuretic solution, is commonly utilized in priming cardiopulmonary bypass (CPB) and can impact kidney function. This study was conducted to investigate the impact of mannitol use during CPB on kidney function in patients undergoing coronary artery bypass surgery. Methods: This randomized, double-blind clinical trial studied 90 patients undergoing coronary artery bypass surgery. In the control group (n=45), the prime solution included Ringer's lactate, and in the intervention group (n=45), the prime solution had 200 ml of mannitol 20% and Ringer's lactate. A P -value<0.05 was considered significant. The primary endpoint of this study is renal function. Results: Demographic characteristics and risk factors were not significantly different between the two groups (P >0.05). Additionally, there was no statistically significant difference between two groups in terms of CPB time, aortic cross-clamp time, length of time connected to mechanical ventilation, 30-day mortality, ICU, and hospital stay time (P >0.05). Furthermore, no statistically significant difference was observed between the two groups in serum creatinine levels (P =0.53) or BUN levels (P =0.13). The study also found no statistically significant difference in the diuresis rate between the two groups (P =0.10). Conclusion: The present study has shown that adding mannitol to the prime has no effect on kidney function, length of time connected to mechanical ventilation, length of stay in the ICU, or 30-day mortality. Therefore, it suggests that mannitol cannot be used as a preventative strategy for acute kidney injury after cardiac surgery. [ABSTRACT FROM AUTHOR]

Introduction: A mainstay in the acute management of diabetic ketoacidosis (DKA) is fluid resuscitation. Normal saline is recommended by the American Diabetes Association; however, it has been associated with hyperchloremic metabolic acidosis and acute kidney injury. Limited literature is available to determine the most appropriate crystalloid fluid to treat patients with DKA. Objective: The purpose of this study was to compare lactated Ringer's (LR) to normal saline (NS) in the acute management of DKA. Methods: This was a retrospective, multicenter single health system cohort study. The primary outcome was to evaluate the time to high anion gap metabolic acidosis (HAGMA) resolution using LR compared to NS. Secondary outcomes included the incidence of nongap metabolic acidosis, hyperchloremia, acute kidney injury, and new renal replacement therapy. Other secondary outcomes included insulin infusion duration and hospital and intensive care unit length of stay. The Cox proportional hazards model was used for the primary outcome. Results: A total of 771 patient encounters were included. Lactated Ringer's was associated with faster time to HAGMA resolution compared to NS (adjusted hazard ratio 1.325; 95% confidence interval 1.121–1.566; p < 0.001). No difference was found in complications such as incidence of nongap metabolic acidosis, hyperchloremia, acute kidney injury, and new renal replacement therapy between the LR and NS groups. Additionally, there was no difference in insulin infusion duration and hospital or intensive care unit length of stay. Conclusion: Treatment with LR as the primary crystalloid for acute DKA management was associated with faster HAGMA resolution compared with NS. Similar incidence in complications and length of stay was observed between the two groups. The findings of this study add to the accumulating literature suggesting that balanced crystalloids may offer an advantage over NS for the treatment of patients with DKA. [ABSTRACT FROM AUTHOR]

The recent identification of bacterial endotoxins in Ringer’s Lactate (RL) from a manufacturing batch by M/s. Vision Parenteral Pvt. Ltd. has raised significant concerns regarding the safety of intravenous solutions. These endotoxins, originating from Gram-negative bacteria, can trigger severe systemic inflammatory responses, worsening conditions like haemorrhagic shock and leading to organ dysfunction and increased mortality. The interaction between RL and endotoxins is particularly problematic, as it can exacerbate inflammation, disrupt fluid balance, and complicate metabolic and immune responses. This situation underscores significant gaps in pharmaceutical manufacturing practices and highlights the urgent need for stricter regulatory oversight and quality control. The healthcare community must reassess the use of RL in clinical settings, particularly in cases where endotoxin contamination could pose a significant risk, to protect patient health and safety.

Background Ringer's lactate (RL) and 0.9% sodium chloride (NS) are used intraoperatively in pediatric surgical patients. The fluid of choice in pediatric neurosurgical patients is still under research. Hence, we compared NS and RL intraoperatively with a primary objective of measuring the absolute difference in serum chloride concentrations (ΔCl-) after surgery from baseline. Secondary objectives included changes in other electrolytes, osmolarity, pH, creatinine, brain relaxation score (BRS), and neurological outcome at discharge using a modified Rankin scale (mRS).

Background Ringer's lactate (RL) and 0.9% sodium chloride (NS) are used intraoperatively in pediatric surgical patients. The fluid of choice in pediatric neurosurgical patients is still under research. Hence, we compared NS and RL intraoperatively with a primary objective of measuring the absolute difference in serum chloride concentrations (ΔCl -) after surgery from baseline. Secondary objectives included changes in other electrolytes, osmolarity, pH, creatinine, brain relaxation score (BRS), and neurological outcome at discharge using a modified Rankin scale (mRS). Methods This prospective randomized trial was conducted in American Society of Anesthesiologists status I to II children, aged 6 months to 14 years, after Institutional Ethical Committee approval and written informed consent. Forty patients were randomized in group-S (received 0.9% Saline) and group-R (received RL). The fluid administration was guided by Pleth Variability Index (target <13%). Arterial blood samples were taken at the start of surgery, during tumor resection, and at the end of surgery. Results Twenty-one patients in NS and 19 patients in RL were enrolled. ΔCl - was 12 (9–16) mmol/L in NS group and 4 (2–15) mmol/L in RL group, p = 0.03. NS group developed more metabolic acidosis (6 [28.6%] vs. 0 [0.0%], p = 0.021). There was no difference in the other electrolytes, serum osmolarity, BRS, perioperative creatinine, and mRS between groups, p = 0.36, p = 0.096, p = 0.658, and p = 0.168, respectively. Conclusion Intraoperative use of NS causes derangement in chloride balance, leading to metabolic acidosis compared to RL in children undergoing neurosurgical procedures. However, there was no difference in the other parameters, including serum osmolarity, BRS, and mRS. [ABSTRACT FROM AUTHOR]

Arthrocentesis is a minimally invasive technique used in treating various temporomandibular disorders. There are various lavaging agents and intra-articular injections used in arthrocentesis viz., Normal Saline (NS), Ringer’s Lactate (RL), Sodium Hyaluronate (SH), Platelet-rich Plasma (PRP), Non-steroidal Anti-inflammatory Drugs (NSAIDs) etc. The present review was conducted to compare the published literature about the efficacy of various lavaging agents and intra-articular injections used in arthrocentesis. It was found that NS and RL are currently the best proven agents for Temporomandibular Joint (TMJ) lavage. It has been observed that lavage combined with intra-articular injections produces better outcomes than lavage alone. Patients who received treatment with arthrocentesis in conjunction with Hylauronic Acid (HA) injection, displayed faster and more noticeable improvement in their perception of pain and maximal mouth opening.

Objective:The type of fluid that should be used in uncontrollable hemorrhages remains an area of research. This study was designed to compare the effects of resuscitation with Ringer’s lactate (RL) solution versus a normal saline (NS) solution on hemodynamics, renal tissue histopathology, coagulation, and apoptosis in a rat model of hemorrhagic shock.Methods:The study employed groups designated as the control, hemorrhage, NS, and RL groups. Heart rate, mean arterial pressure, and respiratory rate were monitored. Annexin A5 values were assayed, rotational thromboelastometry analysis was performed, and excised kidney tissue samples were histopathologically analyzed.Results:Blood pressure levels were found to be significantly higher in the control group than those measured in the other groups. While the clotting time (CT) and clot formation time (CFT) in the hemorrhage group were significantly longer than those in the control and RL groups, the CT and CFT measured in the control group were significantly shorter compared to the RL group. The mean Annexin A5 level was in the hemorrhage group, which was significantly higher compared to the other groups. In the renal histopathological evaluation, the scores of proximal tubular injury, distal renal tubular injury, and interstitial renal tubular injury were found to be significantly lower in the control group compared to the other groups.Conclusion:This study demonstrated that NS or RL can be used safely to improve the hemodynamic symptoms resulting from hemorrhagic shock as a means to reduce apoptosis, and to decrease findings in favor of coagulopathy in bedside coagulation tests during the early stages of hemorrhagic shock until the time of starting a blood transfusion.

Objectives: Given that no study has so far carefully examined the effects and benefits of crystalloids on the hemodynamic status and events during the surgery for lower limb orthopedic surgeries, the current study aimed to compare fluid therapy with normal saline (NS), Ringer (R), and Ringer’s lactate (RL) during anesthesia on the hemodynamic status and events during lower limb elective orthopedic surgeries. Materials and Methods: This cross-sectional descriptive study was conducted in 2019 with the participation of 270 patients (three groups each including 90 subjects) who were scheduled for an elective lower limb orthopedic surgery in Imam Reza hospital of Tabriz. Patients received one of these serums of NS, R, and RL. Electrolytes were measured before and after the surgery. Finally, data were analyzed using ANOVA and chi-square tests. Results: Based on the results, there was no significant difference between the three groups in terms of hemoglobin, hematocrit, sodium, calcium, potassium, chlorine, albumin, creatinine, urea, bicarbonate, pH, and arterial oxygen levels (P>0.05), and RL serum had the least effect on all factors. Conclusions: In general, the administration of NS, R, and RL in lower limb orthopedic surgeries did not result in significant differences although RL had the least adverse effects and was associated with better results.

Epithelial ovarian cancer (EOC) is the most common type of gynecological tumor, presenting poor prognosis at diagnosis and with recurrences being frequently observed. Reactive species generated by physical plasma and transferred into liquids have shown promising results in cancer therapy. Recently, Ringer's lactate solution was exposed to plasma showing selective anticancer activity on EOC cells. In this work, we compared the effect of plasma treatment, using the kINPen plasma jet, on Ringer's saline and Ringer's lactate solution. These two plasma‐treated liquids were analyzed chemically by quantifying reactive species and the extent of lactate oxidation. The biological efficiency of the plasma‐treated liquids was explored in EOC cells. The results show that lactate is affected by plasma treatment, displaying a reduction of cytotoxic potential. [ABSTRACT FROM AUTHOR]

Objectives: Given that no study has so far carefully examined the effects and benefits of crystalloids on the hemodynamic status and events during the surgery for lower limb orthopedic surgeries, the current study aimed to compare fluid therapy with normal saline (NS), Ringer (R), and Ringer's lactate (RL) during anesthesia on the hemodynamic status and events during lower limb elective orthopedic surgeries. Materials and Methods: This cross-sectional descriptive study was conducted in 2019 with the participation of 270 patients (three groups each including 90 subjects) who were scheduled for an elective lower limb orthopedic surgery in Imam Reza hospital of Tabriz. Patients received one of these serums of NS, R, and RL. Electrolytes were measured before and after the surgery. Finally, data were analyzed using ANOVA and chi-square tests. Results: Based on the results, there was no significant difference between the three groups in terms of hemoglobin, hematocrit, sodium, calcium, potassium, chlorine, albumin, creatinine, urea, bicarbonate, pH, and arterial oxygen levels (P>0.05), and RL serum had the least effect on all factors. Conclusions: In general, the administration of NS, R, and RL in lower limb orthopedic surgeries did not result in significant differences although RL had the least adverse effects and was associated with better results. [ABSTRACT FROM AUTHOR]

Arthrocentesis is a minimally invasive technique used in treating various temporomandibular disorders. There are various lavaging agents and intra-articular injections used in arthrocentesis viz., Normal Saline (NS), Ringer's Lactate (RL), Sodium Hyaluronate (SH), Platelet-rich Plasma (PRP), Non-steroidal Anti-inflammatory Drugs (NSAIDs) etc. The present review was conducted to compare the published literature about the efficacy of various lavaging agents and intra-articular injections used in arthrocentesis. It was found that NS and RL are currently the best proven agents for Temporomandibular Joint (TMJ) lavage. It has been observed that lavage combined with intra-articular injections produces better outcomes than lavage alone. Patients who received treatment with arthrocentesis in conjunction with Hylauronic Acid (HA) injection, displayed faster and more noticeable improvement in their perception of pain and maximal mouth opening. [ABSTRACT FROM AUTHOR]

Objective: The type of fluid that should be used in uncontrollable hemorrhages remains an area of research. This study was designed to compare the effects of resuscitation with Ringer's lactate (RL) solution versus a normal saline (NS) solution on hemodynamics, renal tissue histopathology, coagulation, and apoptosis in a rat model of hemorrhagic shock. Methods: The study employed groups designated as the control, hemorrhage, NS, and RL groups. Heart rate, mean arterial pressure, and respiratory rate were monitored. Annexin A5 values were assayed, rotational thromboelastometry analysis was performed, and excised kidney tissue samples were histopathologically analyzed. Results: Blood pressure levels were found to be significantly higher in the control group than those measured in the other groups. While the clotting time (CT) and clot formation time (CFT) in the hemorrhage group were significantly longer than those in the control and RL groups, the CT and CFT measured in the control group were significantly shorter compared to the RL group. The mean Annexin A5 level was in the hemorrhage group, which was significantly higher compared to the other groups. In the renal histopathological evaluation, the scores of proximal tubular injury, distal renal tubular injury, and interstitial renal tubular injury were found to be significantly lower in the control group compared to the other groups. Conclusion: This study demonstrated that NS or RL can be used safely to improve the hemodynamic symptoms resulting from hemorrhagic shock as a means to reduce apoptosis, and to decrease findings in favor of coagulopathy in bedside coagulation tests during the early stages of hemorrhagic shock until the time of starting a blood transfusion. [ABSTRACT FROM AUTHOR]

Background Perioperative hyperglycemia can occur in surgical patients and may increase postoperative morbidity and mortality, especially in patients with diabetes. Therefore, we conducted the present study to evaluate whether the administration of 6% hydroxyethyl starch (HES)-130/0.4 increases blood glucose levels in patients with diabetes. Methods Forty patients undergoing lower limb surgery under spinal anesthesia were randomly allocated into two groups according to the fluids administered 20 min before spinal anesthesia (Group L, lactated Ringer’s solution; Group H, 6% HES-130/0.4). Patient characteristics, intraoperative variables, blood glucose levels, mean blood pressure (MBP), and heart rate (HR) were recorded at five time-points (0, 20, 60, 120, and 240 min). Results A total of 39 patients were analyzed (Group L, n = 20; Group H, n = 19). The amount of intraoperative fluid was significantly higher in Group L than in Group H (718.2 ml vs. 530.0 ml, P = 0.010). There were no significant differences in the changes in blood glucose levels, HR, or MBP between the two groups (P = 0.737, P = 0.896, and P = 0.141, respectively). Serial changes in mean blood glucose levels from baseline also showed no significant differences between the groups (P = 0.764). Conclusions There were no significant changes in blood glucose levels when lactated Ringer’s solution or 6% HES-130 was used. When compared to the lactated Ringer’s solution, no evidence that 6% HES-130/0.4 produces hyperglycemia in diabetic patients could be found. Further evaluation of larger populations is needed.

Background : : Post-endoscopic retrograde cholangiopancreatography pancreatitis (PEP) is a common complication of therapeutic endoscopy. The aim of this trial was to determine whether a combination of rectal diclofenac and vigorous hydration with Ringer's lactate is superior to the corresponding individual treatments for preventing PEP in high-risk patients. Methods : : This randomized, open-label, controlled trial was conducted from August 2020 to January 2022. We included patients who were at high risk of developing PEP. Three intervention groups were made: group A, diclofenac sodium suppository (100 mg); group B, aggressive hydration with Ringer's lactate; group C, a combination of diclofenac and aggressive hydration. PEP was defined as a serum amylase level > 3 times the upper limit of normal with epigastric pain within 24 hours after endoscopic retrograde cholangiopancreatography. Results : : A total of 144 patients were included and 48 cases were randomized to each intervention group. The incidence of PEP was 8.3%, 10.4%, and 8.3% in groups A, B, and C, respectively. A personal history of alcohol consumption and more than one pancreatic duct guidewire cannulation were significantly associated with the development of PEP. Conclusion : : No difference in the incidence of PEP was observed with or without the use of aggressive hydration. Combining aggressive hydration with a rectal nonsteroidal anti-inflammatory drug for preventing PEP cannot be recommended.

It has been documented that hemodynamic disturbances occur in hypovolemic patients. Therefore, the early management of hypovolemia is essential to achieve optimal outcomes. Blood gas, which changes rapidly during hemodynamic instability, can be used as a diagnostic approach for monitoring emergency patients. The objective of the current study was to evaluate the results of resuscitation with hydroxyethyl starch (HES) or lactated Ringer's solution (LR) on venous and arterial blood gas. In addition, the difference between venous and arterial blood gas parameters is investigated to assess the possibility of using venous blood gas analysis as a successor for arterial blood gas analysis in the resuscitation of hypovolemic dogs. Venous and arterial pH, PO2, PCO2, HCO3-, and base excess were analyzed at the end of each study stage as follow: 1) Establishment of anesthesia, 2) Blood collection to an arterial mean pressure of 40-50 mm Hg, 3) Maintaining dogs in a hypovolemic state, 4) Resuscitation with LR (group A) or HES (group B) in four steps, and 5) One hour after the final resuscitation step. Hypovolemia decreased the studied parameters, except venous PCO2, which showed a significant increase (p < 0.05). Fluid resuscitation returned the studied parameters to the control values as venous PCO2 in group A and HCO3- in group B showed a significant change in comparison with the control values (p < 0.05). We found that venous pH, HCO3-, and PCO2 can be used as less invasive and safer alternatives to similar arterial parameters to monitor the fluid resuscitation of hypovolemic dogs.

Abstract Patients with acute pancreatitis (AP) often require ICU admission, especially when signs of multiorgan failure are present, a condition that defines AP as severe. This disease is characterized by a massive pancreatic release of pro-inflammatory cytokines that causes a systemic inflammatory response syndrome and a profound intravascular fluid loss. This leads to a mixed hypovolemic and distributive shock and ultimately to multiorgan failure. Aggressive fluid resuscitation is traditionally considered the mainstay treatment of AP. In fact, all available guidelines underline the importance of fluid therapy, particularly in the first 24–48 h after disease onset. However, there is currently no consensus neither about the type, nor about the optimal fluid rate, total volume, or goal of fluid administration. In general, a starting fluid rate of 5–10 ml/kg/h of Ringer’s lactate solution for the first 24 h has been recommended. Fluid administration should be aggressive in the first hours, and continued only for the appropriate time frame, being usually discontinued, or significantly reduced after the first 24–48 h after admission. Close clinical and hemodynamic monitoring along with the definition of clear resuscitation goals are fundamental. Generally accepted targets are urinary output, reversal of tachycardia and hypotension, and improvement of laboratory markers. However, the usefulness of different endpoints to guide fluid therapy is highly debated. The importance of close monitoring of fluid infusion and balance is acknowledged by most available guidelines to avoid the deleterious effect of fluid overload. Fluid therapy should be carefully tailored in patients with severe AP, as for other conditions frequently managed in the ICU requiring large fluid amounts, such as septic shock and burn injury. A combination of both noninvasive clinical and invasive hemodynamic parameters, and laboratory markers should guide clinicians in the early phase of severe AP to meet organ perfusion requirements with the proper administration of fluids while avoiding fluid overload. In this narrative review the most recent evidence about fluid therapy in severe AP is discussed and an operative algorithm for fluid administration based on an individualized approach is proposed.

Background: Preloading or the infusion of intravenous fluid prior to the induction of spinal anaesthesia has remained the cornerstone in the prevention of spinal induced hypotension for a long time. However, its efficacy in the adult young non-parturient population still has to be conclusively determined as most previous studies have been conducted in the parturient or the non-parturient elderly population. This prospective study was undertaken for the comparative evaluation of the clinical parameters associated with spinal induced hypotension following spinal anaesthesia among three groups, i.e. a no preload group, a crystalloid (Ringer's lactate solution or RL group) preload and colloid (3.5% polygeline solution or polygeline group) preload, in elective lower-abdominal or lower-limb surgery involving minimal blood loss, in a young adult (20 - 50 years) non-parturient population. Material and Methods: 75 ASA-I and ASA-II, young adult (20 - 50 years), non-parturient patients undergoing elective lower abdominal or lower limb surgery, involving minimal blood loss, were randomly allotted into three groups of 25 patients each, in a double-blind clinical trial, to receive either no preload, 3.5% polygeline solution (10 mL kg-1), or Ringer's lactate solution (20 mL kg-1), as a preload before spinal anaesthesia. The measurements of the heart rate (HR), systolic arterial pressure (SAP), mean arterial pressure (MAP) and the peripheral arterial oxygen saturation (SpO2) were recorded on a serial basis. Hypotension was defined as a decrease in the SAP of 25% or more from the baseline (beforepreload) values. The various parameters indicative of the incidence, severity, duration and timing of spinal - induced hypotension (SIH) and the incidence of cardiovascular side-effects such as bradycardia and arrhythmias in all the three groups were recorded. Results: There was a significant difference in the incidence of SIH [68% (no-preload); 24% (polygeline) and 32% (Ringer's lactate); P = 0.003], mean therapeutic requirement of vasopressor (mephentermine) (P = 0.001), mean minimum systolic arterial pressure (P = 0.000), mean minimum systolic arterial pressure (as percent of baseline) (P = 0.000), mean maximal heart rate (P = 0.038), mean number of hypotensive episodes (P = 0.001), mean total duration of hypotension (P = 0.000), and mean peripheral arterial oxygen saturation (SpO2) (P = 0.000) following spinal anaesthesia between the control, polygeline and Ringer's lactate groups. There was no significant difference in the incidence of SIH [24% (polygeline) vs. 32% (Ringer's lactate); P = 0.529], mean therapeutic requirement of vasopressor (mephentermine) (P = 0.781), mean maximal heart rate (P = 0.923), mean number of hypotensive episodes (P = 0.923), mean total duration of hypotension (P = 0.926), mean peripheral arterial oxygen saturation (SpO2) (P = 0.803) following spinal anaesthesia between the polygeline and Ringer's lactate groups. The mean minimum systolic arterial pressure (P = 0.037) and the mean minimum systolic arterial pressure (as percent of baseline) (P = 0.012) following spinal anaesthesia remained significantly higher in the polygeline group than in the Ringer's lactate group. There was no significant difference in the mean time of recording of the minimum systolic arterial pressure (P = 0.592), the mean duration of a hypotensive episode (P = 0.145) and the incidence of bradycardia [20% (no-preload); 12% (polygeline) and 16% (Ringer's lactate); P = 0.743] following spinal anaesthesia between the control, polygeline and Ringer's lactate groups. A significant difference, if any, in the incidence of arrhythmias following spinal anaesthesia between the three groups could not be found out because of the number of patients developing this side-effect was very less. Conclusion: The polygeline and Ringer's lactate preload were effective in significantly reducing the incidence, severity and duration of SIH, and in maintaining significantly higher mean SpO2 following spinal anaesthesia, when compared to a no-preload. However, there was no significant difference in the mean time of recording of the minimum systolic arterial pressure, the mean duration of a hypotensive episode or the incidence of bradycardia following spinal anaesthesia, between the three groups. There was no definite advantage of a polygeline preload over a Ringer's lactate preload, as there was no significant difference between the two in so far as reducing the incidence, severity and duration of SIH is concerned, or in maintaining significantly higher mean SpO2 following spinal anaesthesia. [ABSTRACT FROM AUTHOR]

BackgroundResuscitation with crystalloid fluid is a cornerstone of pediatric septic shock treatment. However, the optimal type of crystalloid fluid is unknown. We aimed to determine the feasibility of conducting a pragmatic randomized trial to compare balanced (lactated Ringer's [LR]) with 0.9% normal saline (NS) fluid resuscitation in children with suspected septic shock.MethodsOpen-label pragmatic randomized controlled trial at a single academic children's hospital from January to August 2018. Eligible patients were >6 months to

ERCP has been established as a golden diagnostic and therapeutic modality in various pancreatobiliary diseases, including gallstones and malignancy. On the other hand, ERCP is a relatively invasive procedure with radiation hazards and major complications. Among the major complications, ERCP-related pancreatitis has been reported in more than 14.7% of high-risk patients, which might lead to extended hospitalization and a substantial burden for both patients and physicians. Recent guidelines have defined the high-risk factors for ERCP-related pancreatitis. In addition, several outstanding studies have shown that rectal non-steroidal anti-inflammatory drugs, aggressive hydration with lactated Ringer’s solution, and pancreatic stents can reduce ERCP-related pancreatitis in high-risk patients or all patients. A prevention algorithm for ERCP-related pancreatitis was provided based on advanced research.

It has been documented that hemodynamic disturbances occur in hypovolemic patients. Therefore, the early management of hypovolemia is essential to achieve optimal outcomes. Blood gas, which changes rapidly during hemodynamic instability, can be used as a diagnostic approach for monitoring emergency patients. The objective of the current study was to evaluate the results of resuscitation with hydroxyethyl starch (HES) or lactated Ringer's solution (LR) on venous and arterial blood gas. In addition, the difference between venous and arterial blood gas parameters is investigated to assess the possibility of using venous blood gas analysis as a successor for arterial blood gas analysis in the resuscitation of hypovolemic dogs. Venous and arterial pH, PO2, PCO2, HCO3-, and base excess were analyzed at the end of each study stage as follow: 1) Establishment of anesthesia, 2) Blood collection to an arterial mean pressure of 40-50 mm Hg, 3) Maintaining dogs in a hypovolemic state, 4) Resuscitation with LR (group A) or HES (group B) in four steps, and 5) One hour after the final resuscitation step. Hypovolemia decreased the studied parameters, except venous PCO2, which showed a significant increase (p < 0.05). Fluid resuscitation returned the studied parameters to the control values as venous PCO2 in group A and HCO3- in group B showed a significant change in comparison with the control values (p < 0.05). We found that venous pH, HCO3-, and PCO2 can be used as less invasive and safer alternatives to similar arterial parameters to monitor the fluid resuscitation of hypovolemic dogs. [ABSTRACT FROM AUTHOR]

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Patients with acute pancreatitis (AP) often require ICU admission, especially when signs of multiorgan failure are present, a condition that defines AP as severe. This disease is characterized by a massive pancreatic release of pro-inflammatory cytokines that causes a systemic inflammatory response syndrome and a profound intravascular fluid loss. This leads to a mixed hypovolemic and distributive shock and ultimately to multiorgan failure. Aggressive fluid resuscitation is traditionally considered the mainstay treatment of AP. In fact, all available guidelines underline the importance of fluid therapy, particularly in the first 24–48 h after disease onset. However, there is currently no consensus neither about the type, nor about the optimal fluid rate, total volume, or goal of fluid administration. In general, a starting fluid rate of 5–10 ml/kg/h of Ringer's lactate solution for the first 24 h has been recommended. Fluid administration should be aggressive in the first hours, and continued only for the appropriate time frame, being usually discontinued, or significantly reduced after the first 24–48 h after admission. Close clinical and hemodynamic monitoring along with the definition of clear resuscitation goals are fundamental. Generally accepted targets are urinary output, reversal of tachycardia and hypotension, and improvement of laboratory markers. However, the usefulness of different endpoints to guide fluid therapy is highly debated. The importance of close monitoring of fluid infusion and balance is acknowledged by most available guidelines to avoid the deleterious effect of fluid overload. Fluid therapy should be carefully tailored in patients with severe AP, as for other conditions frequently managed in the ICU requiring large fluid amounts, such as septic shock and burn injury. A combination of both noninvasive clinical and invasive hemodynamic parameters, and laboratory markers should guide clinicians in the early phase of severe AP to meet organ perfusion requirements with the proper administration of fluids while avoiding fluid overload. In this narrative review the most recent evidence about fluid therapy in severe AP is discussed and an operative algorithm for fluid administration based on an individualized approach is proposed. [ABSTRACT FROM AUTHOR]

Disclaimer: In an effort to expedite the publication of articles, AJHP is posting manuscripts online as soon as possible after acceptance. Accepted manuscripts have been peer-reviewed and copyedited, but are posted online before technical formatting and author proofing. These manuscripts are not the final version of record and will be replaced with the final article (formatted per AJHP style and proofed by the authors) at a later time., Purpose: We describe the implementation of a fluid conservation strategy in a 2-hospital community health system and its effects on utilization of 1,000-mL bags of 0.9% sodium chloride and lactated Ringer's solution., Summary: Disruptions to medical supply chains are unpredictable and can cause significant impacts on patient care. A fluid conservation strategy including guidance statements and mandatory order modifications in a 2-hospital community health system was associated with decreases in the use of 1,000-mL bags of 0.9% sodium chloride and lactated Ringer's solutions of 52% and 39%, respectively, compared with the utilization rates over the prior year., Conclusion: Institutions facing shortages should consider multidisciplinary strategies with trackable metrics when faced with supply chain disruptions., (© American Society of Health-System Pharmacists 2024. All rights reserved. For commercial re-use, please contact reprints@oup.com for reprints and translation rights for reprints. All other permissions can be obtained through our RightsLink service via the Permissions link on the article page on our site—for further information please contact journals.permissions@oup.com.)

Background: 0.9% saline commonly used for resuscitation of septic patients might induce biochemical changes leading to detrimental effects. Ringer's lactate being a balanced crystalloid might be beneficial in such a scenario. Objectives: We undertook this study to explore in detail the effect of these fluids in the resuscitation of septic patients, and risks and benefits these two fluids would have on the overall prognosis of patients. Methods: This was an open-label randomized controlled trial undertaken in emergency medical services attached to the department of medicine at a tertiary care teaching hospital. One hundred sixty adult (⩾18 years old) medical patients admitted with the diagnosis of sepsis fulfilling eligibility criteria were included. They were randomly assigned to receive 0.9% saline or ringer's lactate. These fluids were given for the initial 24 h only, and after then, the type of fluid given was based on treating physician discretion. Various biochemical parameters were measured at baseline and various time points during the hospital stay. The primary outcome was to find out the incidence of hyperchloremia at 24 h from the time of randomization and during the hospital stay. The secondary outcomes were incidence of acute kidney injury, need for renal replacement therapy; differences in pH, bicarbonate, serum lactate, coagulation parameters, sequential organ failure assessment scores at various time points; and hospital/30-day mortality. Results: The baseline characteristics in both groups were comparable. At admission, each group had a serum chloride value which was comparable (p value: 0.595); however, at 24 and 48 h, a statistically significant difference was noticed, with 0.9% saline group having a higher mean serum chloride value (113.66 ± 10.04 v/s 108.98 ± 8.04 mEq/L, p value: 0.001 at 24 h) and (114.75 ± 9.51 v/s 111.12 ± 7.84 mEq/L, p value: 0.022 at 48 h). At 24 and 48 h post-randomization, the incidence of hyperchloremia was significantly higher in the 0.9% saline group (at 24 h, 0.9% saline: 75.0% v/s Ringer's lactate: 48.8%, p value: 0.001 and at 48 h, 0.9% saline: 77.2% v/s Ringer's lactate: 60.3%, p value: 0.022), although there was no difference in the incidence of hyperchloremia recorded during the hospital stay. Acute kidney injury incidence at 24 and 48 h post-randomization was significantly higher in the 0.9% saline group (at 24 h, 0.9% saline: 23.8% v/s Ringer's lactate: 10.0%, p value: 0.020 and at 48 h, 0.9% saline: 29.1% v/s Ringer's lactate: 15.4%, p value: 0.039). No significant differences in other secondary outcomes were observed. Conclusion: Higher incidence of hyperchloremia and a higher rate of acute kidney injury at 24 and 48 h after randomization were noted in the 0.9% saline group. [ABSTRACT FROM AUTHOR]

This study aimed to compare the effects of infusion of normal saline, 1/3-2/3, and Ringer's lactate fluids on labour outcome, pH, bilirubin, and glucose level of umbilical cord blood. In this randomised clinical trial, 450 nulliparous women with Bishop score ˂5 and indication of pregnancy termination were randomly divided into three groups to receive normal saline, 1/3-2/3, or Ringer's lactate infusion at a rate of 125 mL/h for hydration, upon starting induction of labour. Results of this study indicated that the incidence of hypoglycaemia (p =.19), hyper bilirubinemia (p =.87) and acidosis (p =.10) was similar in neonates of the three groups. Also, there were no statistically significant differences between the three groups with regard to the duration of labour; glucose, bilirubin and pH level of cord blood; and mode of delivery. It can be concluded that infusion of Ringer's lactate, normal saline or 1/3-2/3 fluid during labour is not associated with different maternal or foetal/neonatal outcomes, and none of the fluids has superiority to the others. What is already known on this subject? Several studies have been conducted on the association between type and volume of infused fluid on labour duration and neonatal outcomes. However, there has been some controversy. What do the results of this study add? This is the first study that has investigated the association between infusion of Ringer's lactate, normal saline or 1/3-2/3 fluid during labour with labour outcome and pH, bilirubin, and glucose level of the umbilical cord blood and results showed that these fluids have no effect on maternal or foetal/neonatal outcomes and also none of these fluids has superiority to the others. What are the implications of these findings for clinical practice and/or further research? Due to contradictory results of previous studies, further research with greater sample sizes and different fluids type and volumes may be needed to examine the association between infusion of fluids and neonatal and labour outcomes more precisely. [ABSTRACT FROM AUTHOR]

Background: We aimed to compare outcomes according to a Lactated Ringers (LR) versus Normal Saline (NS)-based strategy for acute pancreatitis. Methods: A database search through November 2020 was done to identify studies comparing LR to NS for fluid rehydration in AP. The primary endpoint was systemic inflammatory response syndrome (SIRS) at 24 h. Mantel–Haenszel pooled odds ratios (OR) and 95% confidence intervals were constructed using a random effects model. Heterogeneity was assessed using the I2 statistic. Publication bias was assessed using funnel plots. Results: Six studies were included totaling 549 patients. No difference in the odds of developing SIRS was noted at 24 h (pooled OR 0.59, 95% CI 0.22–1.62, P = 0.31) between LR and NS. I2 indices showed low heterogeneity between the groups, and a funnel plot showed no obvious publication bias. There was no difference between LR and NS found for SIRS at 48 and 72 h, mortality, and other secondary outcomes. LR was associated with a decreased need for ICU admission. Conclusions: This updated meta-analysis does not support the previously published finding that the use of LR (rather than NS) leads to a statistically significant decreased odds of SIRS in acute pancreatitis. [ABSTRACT FROM AUTHOR]

Background Normal saline solution (NSS) has been the fluid of choice for renal transplant patients, but it can lead to hyperchloremic acidosis and hyperkalemia. This study was performed to compare the safety profile of low-chloride solutions with that of NSS in renal transplant patients. Methods We conducted a systemic review search on PubMed, Embase, and the Central Cochrane Registry. Randomized clinical trials (RCTs) and matched cohort studies involving NSS as the control arm and low-chloride solutions as an intervention arm were chosen. The standardized mean difference for continuous variables, the odds ratio (OR) for discrete variables, and a 95% confidence interval (CI) for effect sizes were used. A p-value of

Background & objective: Normal saline is the most commonly used fluid in traumatic brain injury (TBI) patients both in resuscitation and maintenance since long time but associated with hyperchloremic metabolic acidosis. Balanced salt solutions (BSS) are recently developed with favorable outcome in resuscitation and intraoperative as a maintenance fluid. We compared normal saline and BSS as maintenance fluids in TBI patients admitted to intensive care unit. Methodology: After institutional ethical committee approval and written informed consent from patients' relatives, 100 patients who meet inclusion criteria were randomly divided into two equal groups; Group NS: to receive normal saline as a maintenance fluids and Group BSS: to receive BSS as a maintenance fluid. Data of serum electrolyte and acid base status were collected on day 1, 3, 5, 7 and 14. Patient outcome was evaluated on day-8. Data was analyzed with appropriate statistical tests. The P < 0.05 indicated that the difference was significant. Results: In both groups pH gradually increased over time and was more alkaline in normal saline group. Base excess was comparable between two groups. In normal saline group, serum sodium and chloride increased gradually and reached on the higher side on day-14, while potassium level dropped to a lower side. Twenty-eight days mortality was more in Group NS than the Group BSS. Conclusion: Balanced salt solution causes lesser alterations in acid base and electrolyte status than the normal saline and is associated with more favorable outcome. [ABSTRACT FROM AUTHOR]

Objective: Ringer's lactate (RL) was one of the perfusion fluid used in renal transplants, which were replaced by perfusion fluid with an intracellular composition like histidine-tryptophan-ketoglutarate (HTK) solution. These are preferred in cadaveric renal transplants. However, there are no guidelines for live-related donor renal transplant. We study whether HTK solution is better than RL solution, an extracellular composition fluid in preserving allograft in live-related donor renal transplantation. Materials and Methods: A single-blinded randomized trial comparing HTK solution and RL solution in 80 patients undergoing live-related donor renal transplantation from July 2017 to June 2018. The outcome was measured in serum cystatin C and plasma malondialdehyde (MDA) and serum creatinine for 30 days. Results: In 19 cases, surgeons preferred HTK solution as perfusion fluid due to the presence of multiple arteries; hence, these cases are removed from analysis due to deviation from the study protocol. Four patients in the HTK group and five patients in the RL group were excluded due to loss to follow-up. Recipient age, sex, and donor age, sex, and basic disease were comparable in both groups. The higher warm ischemia in the HTK group (5.58 min [standard deviation (SD) 1.44 min]) as compared to the RL group (5.00 min [SD 1.12 min]) with P 0.096. Similarly, the longer cold ischemia in the HTK group (82.00 min [SD 21.31 min]) as compared to the RL group (70.32 min [SD 24.56 min]) with P 0.783. 8.3% rejection in the HTK group and 17.9% rejection in the RL group. Serum cystatin C, marker of glomerular filtration was comparable, HTK group ((3.75 ± 1.98 mg/l) and RL (3.94 ± 1.68 mg/l) with P 0.714. The plasma MDA marker of ischemia-reperfusion injury was also comparable HTK group (80.16 ± 80.08 ng/ml) and RL group (61.50 ± 92.23 ng/ml) with a P 0.446. Fall in serum creatinine was significantly more in the HTK group than RL. At the end of 30 days, both groups had similar levels of serum creatinine level. Conclusion: Graft perfused by HTK solution and RL solution at our center had comparable 30-day outcomes. Although none of the differences was statistically significant, the HTK group had consistently better metrics in terms of fall in creatinine and serum cystatin C despite a trend to longer ischemia times and higher plasma MDA levels.

Abstract Background Induction of general anesthesia increases the hemodilution resulting from infusion of crystalloid fluid, which is believed to be due to slower distribution caused by arterial hypotension. When normal distribution returns is not known. Methods An intravenous infusion of 25 mL kg− 1 of Ringer’s lactate was infused over 30 min to 25 volunteers just after induction of general anesthesia for open abdominal hysterectomy. A two-volume model was fitted to the repeated measurements of the blood hemoglobin concentration and the urinary excretion using mixed-effects modelling software. Individual-specific covariates were added in sequence. Results Distribution of infused fluid was interrupted during the first 20 min of the infusions. During this time 16.6 mL kg− 1 of lactated Ringer’s had been infused, of which virtually all remained in the circulating blood. Thereafter, the fluid kinetics was similar to that previously been found in awake volunteers except for the elimination rate constant (k 10), which remained to be very low (0.86 × 10− 3 min− 1). Redistribution of infused fluid from the interstitium to the plasma occurred faster (higher k 21) when the arterial pressure was low. No covariance was found between the fixed parameters and preoperatively concentrated urine, the use of sevoflurane or propofol to maintain the anesthesia, or the plasma concentrations of two degradation products of the endothelial glycocalyx, syndecan-1 and heparan sulfate. Conclusions Induction of general anesthesia interrupted the distribution of lactated Ringer’s solution up to when 16.6 mL kg− 1 of crystalloid fluid had been infused. Plasma volume expansion during this period of time was pronounced. Trial registration Controlled-trials.com ( ISRCTN81005631 ) on May 17, 2016 (retrospectively registered).

Objective: This study aimed to investigate the effect of plasma-activated Ringer's lactate solution (PAL) on oral squamous cell carcinoma (OSCC) cells and carcinogenic processes with a particular focus on iron and collagenous matrix formation., Materials and Methods: We used three OSCC cell lines, one keratinocyte cell line, and two fibroblast lines, and cell viability assays, immunoblotting, flow cytometry, and transmission electron microscopy were performed to evaluate the effect and type of cell death. The effect of PAL treatment on lysyl oxidase (LOX) expression was investigated in vitro and in vivo. Tamoxifen-inducible Mob1a/b double-knockout mice were used for the in vivo experiment., Results: PAL killed OSCC cells more effectively than the control nontumorous cells and suppressed cell migration and invasion. Ferroptosis occurred and the protein level of LOX was downregulated in cancer cells in vitro and in vivo. Additionally, PAL improved the survival rate of mice and suppressed collagenous matrix formation., Conclusions: We demonstrated that PAL specifically kills OSCC cells and that ferroptosis occurs in vitro and in vivo. Furthermore, PAL can prevent carcinogenesis and improve the survival rate of oral cancer, especially tongue cancer, by changing collagenous matrix formation via LOX suppression., (© 2023 The Authors. Oral Diseases published by Wiley Periodicals LLC.)

Introduction: Fluid resuscitation is fundamental in the management of septic patients. Among the solutions used, 0.9% saline (SS) remains controversial because it may increase the incidence of acute kidney injury (AKI) in adult patients with sepsis or septic shock compared to Ringer's Lactate (RL). Objective: Compare the use of SS with RL, to determine which fluid shows a lower incidence of AKI in patients with sepsis or septic shock in the emergency services (ES) and in the intensive care units (ICU). Methods: We did a systematic review of studies published in PubMed, Scopus and Web of Science in the last 5 years, using the PRISMA-P and PICO methods. We used the following MeSH terms: "sepsis", "fluid therapy", "crystalloids solutions", "acute kidney injury", "emergency service, hospital" and "intensive care units", excluding studies in animals, pediatrics population and pregnant women. Results: We included 4 studies (n = 18577). The first one showed a decrease in the incidence of AKI when using RL vs SS at 24 and 48 hours of admission in the ES (p<0,05). In the other studies, there was no significant difference found in AKI incidence in the patients admitted in the ICU (p-value = 0,39), (OR 0,91; 95% IC 0,82-1,01) and (OR 0,79; 95% IC 0,63-1,00), respectively. Conclusion: There is a slight evidence that shows that RL would be a better fluid for the treatment in this kind of patients. However, more studies are needed to assure this affirmation. [ABSTRACT FROM AUTHOR]

AIM: To compare the difference between using Ringer's and Ringer's lactate(RL)solutions as irrigating solutions during phacoemulsification and investigate their effect on corneal endothelium.METHODS: This was a prospective interventional double blinded clinical study that included 100 eyes of 100 patients aged between 50 to 65 years suffering from a visually significant age-related cataract and scheduled for routine uncomplicated phacoemulsification. The included eyes were randomly divided into two equal groups(each group included 50 eyes). Group 1 received Ringer's solution and group 2 received Ringer's lactate as an irrigating solution.RESULTS: The first group with Ringer's solution had a mean age of 57.5±8 years and the second group with RL solution had a mean age of 58.6±9 years. After 3mo, endothelial cell density decreased in group 1 by a mean of 8.5%, and in group 2 by a mean of 3.6%(P=0.013). Additionally, central corneal thickness increased in group 1 by a mean of 6.9% and in group 2 by a mean of 1.5%(P=0.006). By correlating the percentage of change in pachymetry and specular microscopic parameters with volume of irrigation solution used, there was no significant correlation.CONCLUSION: The use of Ringer's lactate as an irrigating solution is associated with less endothelial cell loss postoperatively in comparison to Ringer's solution and also associated with decreased postoperative edema.

Background: Whether intraoperative use of hydroxyethyl starch (HES) solutions is associated with postoperative acute kidney injury (AKI) continues to be researched. Urinary neutrophil gelatinase-associated lipocalin (NGAL) is validated for early detection of AKI. Previous studies are limited and use empirically predefined volumes of HES solutions with serum creatinine as marker for AKI. Materials and Methods: Adults scheduled for orthopedic surgery under general anesthesia with >200–300 mL blood loss expected were included; 40 were randomized to receive 6% HES 130/0.4 (tetrastarch) (group HES) or Ringer's lactate (group RL) boluses when stroke volume variation (SVV) >10% in supine or lateral position, or >14% in prone position. Incidence of early postoperative AKI using urinary NGAL (>100 ng/mL) was the primary outcome, and using derangement of serum creatinine was the secondary measure. Results: In 38 patients, intervention was completed, and incidence of AKI (postoperative urinary NGAL >100 ng/mL) among them was 0% in both groups. Patients with urinary NGAL >50 ng/mL were insignificantly higher for group RL versus group HES (6/19 vs. 4/19) (P = 0.461), as were those with incidence of AKI as per creatinine values (5/19 vs. 4/19) (P = 1.000). Group RL had significantly higher requirement of fluid (1211 ± 758 mL vs. 689 ± 394 mL) (P = 0.013) and lower cardiac index (P < 0.05) versus group HES. Conclusion: SVV-guided tetrastarch and Ringer's lactate do not result in postoperative AKI diagnosed by urinary NGAL >100 ng/mL; however, an insignificant trend for better renal functions as well as significantly more efficacious volume expansion and hemodynamic stability were seen with tetrastarch instead.

Objective: Ringer's lactate (RL) was one of the perfusion fluid used in renal transplants, which were replaced by perfusion fluid with an intracellular composition like histidine-tryptophan-ketoglutarate (HTK) solution. These are preferred in cadaveric renal transplants. However, there are no guidelines for live-related donor renal transplant. We study whether HTK solution is better than RL solution, an extracellular composition fluid in preserving allograft in live-related donor renal transplantation. Materials and Methods: A single-blinded randomized trial comparing HTK solution and RL solution in 80 patients undergoing live-related donor renal transplantation from July 2017 to June 2018. The outcome was measured in serum cystatin C and plasma malondialdehyde (MDA) and serum creatinine for 30 days. Results: In 19 cases, surgeons preferred HTK solution as perfusion fluid due to the presence of multiple arteries; hence, these cases are removed from analysis due to deviation from the study protocol. Four patients in the HTK group and five patients in the RL group were excluded due to loss to follow-up. Recipient age, sex, and donor age, sex, and basic disease were comparable in both groups. The higher warm ischemia in the HTK group (5.58 min [standard deviation (SD) 1.44 min]) as compared to the RL group (5.00 min [SD 1.12 min]) with P 0.096. Similarly, the longer cold ischemia in the HTK group (82.00 min [SD 21.31 min]) as compared to the RL group (70.32 min [SD 24.56 min]) with P 0.783. 8.3% rejection in the HTK group and 17.9% rejection in the RL group. Serum cystatin C, marker of glomerular filtration was comparable, HTK group ((3.75 ± 1.98 mg/l) and RL (3.94 ± 1.68 mg/l) with P 0.714. The plasma MDA marker of ischemia-reperfusion injury was also comparable HTK group (80.16 ± 80.08 ng/ml) and RL group (61.50 ± 92.23 ng/ml) with a P 0.446. Fall in serum creatinine was significantly more in the HTK group than RL. At the end of 30 days, both groups had similar levels of serum creatinine level. Conclusion: Graft perfused by HTK solution and RL solution at our center had comparable 30-day outcomes. Although none of the differences was statistically significant, the HTK group had consistently better metrics in terms of fall in creatinine and serum cystatin C despite a trend to longer ischemia times and higher plasma MDA levels. [ABSTRACT FROM AUTHOR]

Background and Purpose of the Study: Two of the most critical factors affecting the prognosis of an avulsed tooth after replantation are extraoral dry time and the storage medium in which the tooth was placed before treatment could be rendered. The ability of a storage medium to support cell viability of the periodontal ligament (PDL) can be an important factor in the prognosis, and thus, the aim of this study was to evaluate the efficacy of commonly available storage media. Materials and Methods: Cultured PDL cells of sixty freshly extracted human teeth were randomly divided into four groups of 15 each, Group I: Electral solution, Group II: Ringer's lactate, Group III: Oral rehydration salt liquid (ORS-L), and Group IV: Coconut water. Samples in each group were further divided into three subgroups depending on the time duration they were placed in the storage medium, i.e., 1, 4, and 8 h. Further these samples were subjected to Collagenase assay, the cells were stained with trypan blue and viable PDL cells were counted under light microscope. Results: Statistical analysis showed that Group II demonstrated significantly (P < 0.001) more viable PDL cells in than Groups IV and I, least viable PDL cells are seen with Group III samples. Conclusion: Ringer's lactate maintained highest PDL cell viability followed by coconut water, electoral solution, and ORS-L at various time intervals. More studies with large samples are required to prove the efficacy of Ringer's lactate as viable storage media.

The aim of this study was to produce graphene oxide (GO) coatings on biodegradable AZ31B magnesium (Mg) alloy. GO was synthesized by improved Hummers' method, and a suspension was prepared in deionized water by ultrasonication. GO coatings were developed on AZ31B Mg alloy by electrophoretic deposition (EPD). The EPD parameters, such as voltage and time, were optimized to obtain uniform GO coatings. Characterization was carried out using Fourier transform infrared spectroscopy, X-ray diffraction, atomic force microscopy (AFM), and scanning electron microscopy. GO was found to have a thickness of approximately 0.7–1 nm as determined by AFM. Electrochemical behavior of coatings was evaluated by Tafel analysis and electrochemical impedance spectroscopy (EIS) in Ringer's lactate solution. GO coatings improved the corrosion resistance of the AZ31B Mg alloy by 16× in Ringer's lactate solution as compared to bare Mg alloy. [ABSTRACT FROM AUTHOR]

Introduction: Appropriate early fluid resuscitation is ubiquitous for critically ill patients with metabolic acidosis. Owing to harmful effects of normal saline, commercially prepared balanced salt solutions are being used. However, there is no study comparing use of Ringer's lactate (RL) and commercially available balanced salt solutions in critically ill patients. Materials and methods: A randomized controlled trial was conducted during July 2016 to December 2017. Fifty adult patients admitted to intensive care unit with metabolic acidosis were randomized into group RL or group acetate solution (AC). Respective trial fluid was administered at 20 mL/kg/hour for first hour and 10 mL/kg/hour for second hour. Arterial blood gas analysis samples were taken 15 minutes apart. The fluid resuscitation was continued till pH got corrected to 7.3 or 2 hours, whichever was earlier. The primary aim was to compare time to correct metabolic acidosis in both the groups. The secondary outcomes were the extent of correction of metabolic acidosis, total volume of fluid used, and total cost per patient. Results: Demographic parameters, APACHE II score, and baseline investigations were comparable. The metabolic acidosis got corrected in 12 patients in group AC and 10 patients in group RL (p value = 0.66). The mean time for correction of metabolic acidosis was 57 ± 3.85 minutes in group RL and 56.25 ± 4.22 minutes in group AC (p value =0.95). The extent of correction of metabolic acidosis and total volume of fluid used was also comparable (p value = 0.05). However, the cost of fluid used was significantly higher in group AC (p value < 0.01). Conclusion: During administration of balanced salt solutions, RL or AC, in critically ill patients with metabolic acidosis, AC did not confer any advantage in time to or extent of correction of metabolic acidosis. Clinical significance: There is no difference in acid--base status with use of different types of balanced salt solutions for resuscitation in critically ill patients. [ABSTRACT FROM AUTHOR]

Background: Induction of general anesthesia increases the hemodilution resulting from infusion of crystalloid fluid, which is believed to be due to slower distribution caused by arterial hypotension. When normal distribution returns is not known. Methods: An intravenous infusion of 25 mL kg− 1 of Ringer's lactate was infused over 30 min to 25 volunteers just after induction of general anesthesia for open abdominal hysterectomy. A two-volume model was fitted to the repeated measurements of the blood hemoglobin concentration and the urinary excretion using mixed-effects modelling software. Individual-specific covariates were added in sequence. Results: Distribution of infused fluid was interrupted during the first 20 min of the infusions. During this time 16.6 mL kg− 1 of lactated Ringer's had been infused, of which virtually all remained in the circulating blood. Thereafter, the fluid kinetics was similar to that previously been found in awake volunteers except for the elimination rate constant (k10), which remained to be very low (0.86 × 10− 3 min− 1). Redistribution of infused fluid from the interstitium to the plasma occurred faster (higher k21) when the arterial pressure was low. No covariance was found between the fixed parameters and preoperatively concentrated urine, the use of sevoflurane or propofol to maintain the anesthesia, or the plasma concentrations of two degradation products of the endothelial glycocalyx, syndecan-1 and heparan sulfate. Conclusions: Induction of general anesthesia interrupted the distribution of lactated Ringer's solution up to when 16.6 mL kg− 1 of crystalloid fluid had been infused. Plasma volume expansion during this period of time was pronounced. Trial registration: Controlled-trials.com (ISRCTN81005631) on May 17, 2016 (retrospectively registered). [ABSTRACT FROM AUTHOR]

Context: It is common practice to avoid lactate-containing intravenous fluids in diabetic patients as it was hypothesized to cause hyperglycaemia by the conversion of lactate to glucose by hepatic gluconeogenesis. However, absence of sound theoretical basis, conflicting reports from numerous clinical trials and improved understanding of biochemistry have necessitated a closer scrutiny of this hypothesis. Aims: The present study aims to determine the effect of 0.9% saline and Ringer's lactate on blood glucose levels in the fasting diabetic surgical patients receiving spinal anaesthesia. Settings and design: The study is a prospective randomized trial conducted on adult patients aged 30 -- 85 years with well-controlled type 2 diabetes mellitus receiving spinal anaesthesia. Methods and material: 120 patients with well-controlled type 2 diabetes mellitus receiving spinal anaesthesia were randomized to receive either 1 litre of 0.9% saline or Ringer's lactate. Blood glucose levels were recorded using a glucometer by the pinprick method before and after infusion of 1 litre of the selected intravenous fluid. Statistical analysis: Data analysis was done using SPSS statistical package - Version 22.0. Student's unpaired 't' test was used to test the significance of difference between quantitative variables. A 'p' value less than 0.05 was taken to denote statistical significance. Results: Mean change in blood glucose levels after infusion of the intravenous fluid in 0.9% saline and Ringer's lactate groups were 3.68±15.2 mg/dl and - 0.15±16.5 mg/dl, respectively. The difference between the two groups was not statistically significant with a 'p' value of 0.188. Conclusions: Ringer's lactate solution, when compared to 0.9% saline, does not cause significant change in the mean blood glucose levels in fasting diabetic patients receiving spinal anaesthesia. [ABSTRACT FROM AUTHOR]

Objective: To compare ringer's lactate and normal saline fluid replacement in pediatric patients with acute watery diarrhoea in terms of mean serum bicarbonate, potassium and pH. Study Design: Quasi experimental study. Place and Duration of Study: This study was conducted at the department of Pediatrics, Pak Emirates Military Hospital, Rawalpindi from Feb 2015 to Jul 2015. Methodology: This study involved 206 children of both genders aged between 1-5 years with watery diarrhoea and severe dehydration. These patients were randomly divided into two treatment groups each comprising of 103 patients. Patients in group-A received ringer's lactate while group-B patients were given normal saline as replacement fluids. Results: The mean age of the patients was 3.34 ± 1.19 years and there were 112 (54.4%) male and 94 (45.6%) female patients. Both the groups were comparable in terms of mean age (p=0.861) and gender distribution (p=0.576). After 6 hours of initiating fluid therapy, mean serum bicarbonate (13.61 ± 2.41 vs. 9.72 ± 2.07 meq/l; p<0.001) and mean blood pH (7.46 ± 0.02 vs. 7.38 ± 0.03; p<0.001) were significantly higher in children treated with ringer's lactate as compared to normal saline. While there was no significant difference between the two groups (4.35 ± 0.61 vs. 4.27 ± 0.58 meq/l; p=0.319) in terms of mean serum potassium level. Conclusion: Fluid replacement with ringer's lactate was superior to normal saline in terms of significantly higher mean serum bicarbonate and mean blood pH after 6 hours of initiating therapy while it was equally safe and only caused insignificant increase in mean serum potassium level. [ABSTRACT FROM AUTHOR]