Glucose monohydrate 20g / Sodium chloride 3.5g / Sodium bicarbonate 2.5g oral powder sachets

BackgroundEx vivo lung perfusion (EVLP) supports assessment and rehabilitation of donor lungs. It runs as a closed circuit, so electrolytes and metabolites accumulate over the duration of perfusion. This systematic review investigates the impact of various dialysis or perfusate exchange (PE) techniques on electrolyte balance, inflammation and lung function during EVLP.MethodsA literature search of PubMed and Embase was conducted from database inception to September 17, 2025. We included all articles describing human or animal studies that tested dialysis or PE during EVLP. Outcomes included electrolytes, lactate, pH, edema formation, lung performance characteristics, and inflammatory markers.ResultsFive studies met the inclusion criteria, one human and four porcine models, with a total of 57 subjects. Across studies, dialysis consistently improved solute clearance, lowering sodium, potassium, and chloride, while increasing calcium and glucose, reducing lactate accumulation, and maintaining physiologic pH. PE did not sustain physiologic pH and had limited impact on electrolyte homeostasis, with only transient effects on lactate. No differences were observed in lung function parameters including oxygenation, compliance, and airway pressure. Pro-inflammatory cytokine production was largely unchanged, however, interleukin (IL)-10 was elevated with dialysis in several studies.ConclusionDuring EVLP, dialysis stabilized acid-base status and metabolites. These biochemical gains did not translate into consistent improvements in oxygenation or compliance. Smaller dialysis membranes were associated with higher pulmonary artery pressure (PAP) and increased cytokine profile. Future studies should extend EVLP duration with perfusate clearance to evaluate whether perfusate clearance strategies provide additional benefits with longer duration preservation.

Abstract licence: CC BY-NC-ND

ObjectiveTo systematically synthesize evidence from RCTs that evaluate the efficacy and safety of balanced crystalloids compared with normal saline for initial fluid resuscitation of patients with DKA.MethodsThis systematic review and meta-analysis were performed considering PRISMA guidelines and was registered in PROSPERO. A comprehensive search was performed to identify RCTs comparing balanced crystalloids with normal saline in adults and children with DKA. The risk of bias was assessed by using Cochrane RoB 2 tool. A random-effects meta-analysis was performed using R software to calculate pooled Mean Differences for continuous outcomes and Odds Ratios for dichotomous outcomes with 95% Confidence Intervals.ResultsEleven RCTs were included. In the quantitative synthesis of six RCTs (n = 491) using continuous time-to-event data, balanced crystalloids were not associated with a statistically significant reduction in time to DKA resolution compared with normal saline (Mean Difference [MD] = -1.50 hours; 95% CI: -3.79 to 0.79; p=0.15), with moderate heterogeneity (I2 = 36.2%). The 95% prediction interval ranged from -5.44 to 2.44 hours. However, balanced crystalloids resulted in a significantly greater increase in serum bicarbonate at 12 hours (MD = +2.50 mmol/L; 95% CI: 1.51 to 3.48; p=0.004; I2 = 0.0%). Subgroup analyses by fluid type, DKA severity, and age group showed no significant subgroup differences.ConclusionInitial fluid resuscitation with balanced crystalloids was not associated with a shorter time to DKA resolution compared with normal saline, and they were associated with a rapid increase in serum bicarbonate levels; however, this biochemical improvement did not translate into a shorter time to DKA resolution or other clinical benefits. The choice of crystalloids for initial DKA resuscitation remains an area of clinical equipoise because of the substantial heterogeneity and methodological limitations of the available evidence, emphasizing the need for further high-quality research.

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Peritoneal dialysis (PD) offers many advantages over hemodialysis but chronic exposure to bio-incompatible glucose-based PD solutions and continuous absorption of glucose from the dialysate may lead to peritoneal membrane (PM) dysfunction and systemic metabolic complications such as hyperglycemia, insulin resistance, dyslipidemia, and obesity. Replacing one daily exchange of 1.36% glucose-based solution with one 1.1% amino acid-based PD solution may provide nutritional benefits of amino acid supplementation, improve biocompatibility, and reduce the peritoneal glucose load while maintaining similar ultrafiltration and solute removal capacity. Randomized clinical trials and mechanistic studies show beneficial effects of amino acid-based PD solutions on peritoneal homeostasis, preserved viability of the PM, and favorable nutritional and metabolic effects. This systematic review highlights the clinical rationale for implementing use of amino acid-based PD solutions as an integral part of glucose-sparing strategies in PD to reduce the cumulative intraperitoneal glucose load and mitigate its well-documented adverse effects. Amino acid-based PD solutions emerge as a clinically viable, glucose-free alternative and a nutritionally beneficial option that can improve the nutritional status of PD patients by providing essential amino acids when used as part of a comprehensive glucose-sparing strategy. Targeted use of these solutions, particularly in malnourished or high-risk patients, represents a personalized approach to optimizing peritoneal dialysis outcomes.Clinical trial number: Not applicable.

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ObjectiveThe choice of crystalloid solution considerably affects perioperative outcomes in neurosurgery. This study aimed to evaluate the effects of Plasma-Lyte 148 and 0.9% saline on acid-base and hydroelectrolyte balance in adults undergoing elective neurosurgical procedures.MethodsA double-blind randomized controlled trial was conducted at Botucatu Medical School from November 2019 to May 2020. Patients received either Plasma-Lyte 148 or 0.9% saline at a maintenance rate of 2mL/kg/h, with additional bolus guided by mean arterial pressure and pulse pressure variation. The primary endpoint was arterial pH at the end of surgery.ResultsSixty-eight patients (33 in the Plasma-Lyte 148 group and 35 in the saline group) completed the study. The total median volumes administered (1st-3rd quartiles) were 2,227 (1,416-3,000) and 3,000 (2,000-4,000) mL in the Plasma-Lyte 148 and saline groups, respectively (p=0.107). At procedure completion, Plasma-Lyte 148 demonstrated superior acid-base homeostasis with significantly higher pH (7.39±0.04 versus 7.35±0.05, pConclusionPlasma-Lyte 148 provides superior acid-base homeostasis compared to 0.9% saline in patients undergoing neurosurgery, with significantly better pH, bicarbonate, and base excess profiles while avoiding hyperchloremia. These findings support the preferential use of balanced crystalloids in neurosurgical practice, aligning with current evidence favoring Plasma-Lyte 148 for optimal perioperative fluid management. ReBEC platform registration number: RBR-2592-hd.

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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