Darrow's infusion 1litre bags

BACKGROUND: Sodium lactate–based solutions have been proposed as an alternative to conventional osmotic therapies for intracranial pressure (ICP) control in acute brain injury (ABI). Beyond their osmotic properties, lactate may also act as a cerebral metabolic substrate, although its effects appear context-dependent. The aim of this systematic review was to synthesize available data on lactate-based therapies in ABI, focusing on their effects on intracranial dynamics, cerebral metabolism and neurological outcomes to guide future clinical translation. METHODS: We performed a systematic review of preclinical and clinical studies evaluating exogenous sodium lactate administration in ABI, including traumatic brain injury, ischemic stroke, and cardiac arrest. Outcomes of interest included intracranial pressure control, cerebral metabolism, cerebral perfusion and oxygenation, systemic hemodynamics, safety, and functional recovery. RESULTS: Twelve preclinical and twelve clinical studies were included. Across most models, sodium lactate was effective in reducing ICP and at least as effective and safe as mannitol or hypertonic saline in clinical settings. Several studies reported improved systemic hemodynamic tolerance compared with conventional osmotherapy. Preclinical and clinical metabolic data demonstrated that lactate can be taken up and oxidized by the injured brain; however, metabolic benefits were inconsistent and appeared dependent on preserved oxidative metabolism, baseline metabolic status, timing, and dose. Functional outcome data were limited but suggested potential cognitive and neurological benefits in both experimental and selected clinical settings. CONCLUSIONS: Sodium lactate is an effective therapy for intracranial hypertension and may offer additional metabolic and systemic advantages in ABI patients under specific conditions. Its metabolic effects appear critically dependent on preserved oxidative capacity, highlighting the need for improved patient selection and the potential role of metabolic monitoring to guide therapy. The impact of lactate-based treatments on meaningful functional outcomes remains uncertain and warrants further investigation in targeted clinical trials.

Abstract licence: CC BY-NC-ND

Diabetic ketoacidosis (DKA) is a life-threatening metabolic complication of diabetes mellitus requiring aggressive intravenous fluid resuscitation. Although the recommended fluid has always been 0.9% normal saline (NS), its supraphysiological chloride load may induce hyperchloremic metabolic acidosis, potentially complicating DKA management. Balanced crystalloids (BCs), with electrolyte compositions more closely approximating human plasma, have emerged as potentially advantageous alternatives. This systematic review compares the clinical outcomes of NS with BCs for fluid resuscitation in patients with DKA. A comprehensive literature search was conducted in PubMed/MEDLINE, Scopus, Embase, and CENTRAL (2021-2026) following PRISMA guidelines. Studies that directly compared 0.9% NS with BCs (such as lactated Ringer's (LR) solution, Plasma-Lyte 148, Isolyte, Sterofundin, or other balanced electrolyte solutions (BES)) for DKA resuscitation were included. The outcomes of interest included time to DKA resolution, electrolyte profiles, insulin infusion duration, length of stay (LOS), acute kidney injury (AKI), and mortality. The risk of bias (ROB) was assessed using the Risk of Bias in Non-randomized Studies of Interventions (ROBINS-I) (for non-randomized studies) and RoB 2 (for randomized controlled trials (RCTs)). Nine studies, four RCTs and five non-randomized studies, comprising 1416 patients, met the inclusion criteria. BCs consistently reduced hyperchloremia and improved bicarbonate profiles compared with NS. Insulin infusion duration was significantly shorter with BCs in two studies. Length-of-stay outcomes were mixed, with some studies showing shorter hospital or ICU stays with BCs. No significant differences in AKI incidence or mortality were observed between groups. The ROB ranged from moderate to substantial, although the RCTs demonstrated a lower ROB than the retrospective cohort studies. BCs demonstrated superior electrolyte profiles and comparable safety compared with NS in DKA. However, their effect on clinically meaningful outcomes such as time to DKA resolution remains uncertain. While the biochemical advantages support consideration of BC, definitive practice recommendations await higher-certainty evidence.

Abstract licence: CC BY

BackgroundAdministration of intravenous fluids prior to competition is common at major equestrian competitions, yet few studies have evaluated the benefits of this practice.Aims/objectiveThe hypothesis was that pre-ride intravenous fluid therapy would be associated with a lower heart rate and improved laboratory hydration parameters during or after the ride.Methods14 client owned horses entered in a 45 km ride in extreme heat and terrain were randomly assigned to receive IV fluids (IVF) or no IV fluids (NIV) the day before the ride. Blood samples and physical examination findings were collected at 6 time points: Home (T0), check in the day before the ride (T1), 2-3 h after catheterization and treatment (T2), 1 h pre-ride (T3), 32 km into the ride (T4), and the end of the ride (T5). Physical examination and laboratory parameters (bicarbonate, sodium, potassium, chloride, calcium, glucose, lactate, BUN, creatinine, PCV and total protein) were evaluated using 2-way ANOVA.ResultsThe total protein concentration at T2 was 0.5 g/dL lower in the IVF group (95 % CI, -1.0 to -0.01 g/dL) compared with the NIV. The BUN concentration at T4 was 4 mg/dL lower in the IVF group (p = 0.02; 95 % CI, -7.3 to -0.9 mg/dL) compared with the NIV. There was no significant difference in heart rates between the IVF and NIV group (36 ± 5 bpm and 39 ± 3 bpm, respectively; p = 0.23).ConclusionsThe use of intravenous fluids prior to riding in extreme conditions may not have clinically significant hydration benefits.

Abstract licence: CC BY-NC-ND

IntroductionBicarbonate-buffered crystalloids avoid exogenous lactate and have physicochemical properties distinct from compound sodium lactate (CSL), but direct comparative evidence during major abdominal surgery remains limited.MethodsThis single-center, open-label, randomized non-inferiority trial enrolled high-risk adults undergoing elective major abdominal surgery. Participants received bicarbonate-buffered solution or CSL as the allocated intraoperative crystalloid. The primary estimand was the arithmetic mean difference in standard base excess (SBE) at skin closure (bicarbonate-buffered solution minus CSL). The non-inferiority margin was -1.5 mEq/L. The trial was prospectively registered with the Australian New Zealand Clinical Trials Registry (ACTRN12619001228178).ResultsFifty participants were randomized (25 per group) and received their allocated intervention. End-of-surgery arterial blood gas data were missing for two CSL participants. In the intention-to-treat analysis using multiple imputation, the estimated mean difference in end-of-surgery SBE was -0.42 mEq/L (95% confidence interval [CI], -1.92 to 1.09 mEq/L). The complete-case per-protocol estimate was -0.48 mEq/L (95% CI, -2.02 to 1.06 mEq/L). In both analyses, the lower CI bound was below the prespecified non-inferiority margin; non-inferiority was not established. Secondary outcomes were exploratory; observed end-of-surgery lactate was lower with bicarbonate-buffered solution (median 0.9 vs 1.2 mmol/L; unadjusted P = 0.031), without a corresponding difference in SBE or pH.ConclusionsIn this small trial of hemodynamically stable adults undergoing elective major abdominal surgery, the primary non-inferiority result was inconclusive. The data did not establish interchangeability, equivalence, superiority, or inferiority of the two fluids. As the trial was powered for a physiologic endpoint, no comparative inference can be made about organ dysfunction, postoperative complications, recovery, or mortality. Larger trials with standardized co-interventions and patient-important outcomes are required before routine substitution for CSL can be recommended.

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