The rule regulating pH changes during crystalloid infusion.

Purpose: To define the rule according to which crystalloid solutions characterized by different strong ion difference (SID) modify the acid-base variables of human plasma. Methods: With a previously validated software, we computed the effects of diluting human plasma with crystalloid solutions ([SID] 0-60, 10 mEq/l stepwise). An equation was derived to compute the diluent [SID] required to maintain the baseline pH unchanged, at constant PCO and at every dilution fraction. The results were experimentally tested using fresh frozen plasma, re-warmed at 37°C, equilibrated at PCO 35 and 78 mmHg, at baseline and after the infusion of crystalloid solutions with 0, 12, 24, 36, 48 mEq/l [SID]. Results: The mathematical analysis showed that the diluent [SID] required to maintain unmodified the baseline pH equals the baseline bicarbonate concentration, [HCO], assuming constant PCO throughout the process. The experimental data confirmed the theoretical analysis. In fact, at the baseline [HCO] of 18.3 ± 0.3 mmol/l (PCO 35 mmHg) the pH was 7.332 ± 0.004 and remained 7.333 ± 0.003 when the diluting [SID] was 18.5 ± 0.0 mEq/l. At baseline [HCO] of 19.5 ± 0.3 mmol/l (PCO 78 mmHg) the pH was 7.010 ± 0.003 and remained 7.004 ± 0.003 when the diluting [SID] was 19.1 ± 0.1 mEq/l. At both PCO values infusion with [SID] lower or greater than baseline [HCO] led pH to decrease or increase, respectively. Conclusions: The baseline [HCO] dictates the pH response to crystalloid infusion. If a crystalloid [SID] equals baseline [HCO], pH remains unchanged at constant PCO, whereas it increases or decreases if the [SID] is greater or lower, respectively. [ABSTRACT FROM AUTHOR]

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