Hypertonic Sodium Lactate to Alleviate Functional Deficits Following Diffuse Traumatic Brain Injury: An Osmotic or a Lactate-Related Effect?

Effects of an Iso-Osmotic Chloride-Free Solution With High Strong Ion Difference vs. Ringer's Lactate on Non-Lactate Metabolic Acidosis in Dogs

BACKGROUND

Metabolic acidosis is a common acid-base disorder in critically ill dogs, with fluid therapy being a key but debated treatment. Sodium bicarbonate's risks have spurred interest in safer alternatives such as sodium lactate.

OBJECTIVES

To compare the efficacy of a chloride-free, high strong ion difference solution (H-SID) to Ringer's lactate (RL) for treating metabolic acidosis, hypothesizing the superiority of the H-SID solution.

ANIMALS

Forty-six dogs with metabolic acidosis from two veterinary hospitals.

METHODS

Prospective randomized multicenter study. Dogs were randomly assigned to receive either RL or H-SID at infusion rates of 4 or 10 mL/kg/h for 4 h, based on their volume status. H-SID was compounded with sodium (145 mmol/L), lactate (145 mmol/L), potassium (10 mmol/L), and aspartate (10 mmol/L) in sterile water for injection.

RESULTS

The H-SID group showed a significant increase in BE-ecf (mmol/L) at infusion rates of 4 mL/kg/h (p < 0.001) and 10 mL/kg/h (p < 0.001) when compared to the RL group. At the lower infusion rate, the median increase was 4.1 mmol/L (95% CI: 3.37, 6.71), whereas the RL group exhibited a variation of -0.1 (95% CI: -0.75, 2.2). At the higher infusion rate, the median increase was 11 mmol/L (95% CI: 8.16, 12.52) compared to the RL group variation of 1.3 (95% CI: 0.01, 2.96).

CONCLUSIONS AND CLINICAL IMPORTANCE

Our results indicate a significant alkalizing effect of the H-SID solution in dogs with non-lactic metabolic acidosis, demonstrating a superior effect compared to the RL solution without notable adverse effects.

Neuroprotective effects of lactate and ketone bodies in acute brain injury

The goal of neurocritical care is to prevent and reverse the pathologic cascades of secondary brain injury by optimizing cerebral blood flow, oxygen supply and substrate delivery. While glucose is an essential energetic substrate for the brain, we frequently observe a strong decrease in glucose delivery and/or a glucose metabolic dysregulation following acute brain injury. In parallel, during the last decades, lactate and ketone bodies have been identified as potential alternative fuels to provide energy to the brain, both under physiological conditions and in case of glucose shortage. They are now viewed as integral parts of brain metabolism. In addition to their energetic role, experimental evidence also supports their neuroprotective properties after acute brain injury, regulating in particular intracranial pressure control, decreasing ischemic volume, and leading to an improvement in cognitive functions as well as survival. In this review, we present preclinical and clinical evidence exploring the mechanisms underlying their neuroprotective effects and identify research priorities for promoting lactate and ketone bodies use in brain injury.

Early Plasma Osmolality Levels and Clinical Outcomes in Children Admitted to the Pediatric Intensive Care Unit: A Single-Center Cohort Study

Objective: Identifying high-risk children with a poor prognosis in pediatric intensive care units (PICUs) is critical. The aim of this study was to assess the predictive value of early plasma osmolality levels in determining the clinical outcomes of children in PICUs. Methods: We retrospectively assessed critically ill children in a pediatric intensive care database. The locally weighted-regression scatter-plot smoothing (LOWESS) method was used to explore the approximate relationship between plasma osmolality and in-hospital mortality. Linear spline functions and stepwise expansion models were applied in conjunction with a multivariate logistic regression to further analyze this relationship. A subgroup analysis by age and complications was performed. Results: In total, 5,620 pediatric patients were included in this study. An approximately "U"-shaped relationship between plasma osmolality and mortality was detected using LOWESS. In the logistic regression model using a linear spline function, plasma osmolality ≥ 290 mmol/L was significantly associated with in-hospital mortality [odds ratio (OR) 1.020, 95% confidence interval (CI) 1.010-1.031], while plasma osmolality <290 mmol/L was not significantly associated with in-hospital mortality (OR 0.990, 95% CI 0.966-1.014). In the logistic regression model with plasma osmolality as a tri-categorical variable, only high osmolality was significantly associated with in-hospital mortality (OR 1.90, 95% CI 1.38-2.64), whereas low osmolality was not associated with in-hospital mortality (OR 1.28, 95% CI 0.84-1.94). The interactions between plasma osmolality and age or complications were not significant. Conclusion: High osmolality, rather than low osmolality, can predict a poor prognosis in children in PICUs.