The impact of modified fluid gelatin 4% in a balanced electrolyte solution on plasma osmolality in children—A noninterventional observational study
Background Intravenous fluids for perioperative infusion therapy should be isotonic to maintain the body fluid homeostasis in children. Modified fluid gelatin 4% in a balanced electrolyte solution has a theoretical osmolarity of 284 mosmol L−1, and a real osmolality of 264 mosmol kg H2O−1. Because b...
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| Veröffentlicht in: | Pediatric anesthesia 2022-08, Vol.32 (8), p.961-966 |
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| creator | Rudolf, Daniel Witt, Lars Boethig, Dietmar Rigterink, Vanessa Zander, Rolf Sümpelmann, Robert Dennhardt, Nils Veyckemans, Francis |
| description | Background
Intravenous fluids for perioperative infusion therapy should be isotonic to maintain the body fluid homeostasis in children. Modified fluid gelatin 4% in a balanced electrolyte solution has a theoretical osmolarity of 284 mosmol L−1, and a real osmolality of 264 mosmol kg H2O−1. Because both values are lower than those of 0.9% saline or plasma, gelatin would be expected to be hypotonic in‐vitro and in‐vivo.
Aim
We thus hypothesized that the infusion of gelatin would be expected to decrease plasma osmolality. We performed an in‐vitro experiment and an in‐vivo study to evaluate the impact of gelatin on the osmolality in children.
Methods
In the in‐vitro experiment, full blood samples were diluted with gelatin 4% or albumin (50 g L−1) from 0% (pure blood) to 100% (pure colloid), and the osmolality was measured by freezing‐point depression. In the in‐vivo study, blood gas analyses from children undergoing major pediatric surgery were collected before and after gelatin infusion, and the osmolality was calculated by a modified version of Zander's formula.
Results
In the in‐vitro experiment, 65 gradually diluted blood samples from five volunteers (age 25–55 years) were analyzed. The dilution with gelatin caused no significant changes in osmolality between 0% and 100%. Compared with gelatin, the osmolality in the albumin group was significantly lower between 50% and 100% dilution (p |
| doi_str_mv | 10.1111/pan.14494 |
| format | Article |
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Intravenous fluids for perioperative infusion therapy should be isotonic to maintain the body fluid homeostasis in children. Modified fluid gelatin 4% in a balanced electrolyte solution has a theoretical osmolarity of 284 mosmol L−1, and a real osmolality of 264 mosmol kg H2O−1. Because both values are lower than those of 0.9% saline or plasma, gelatin would be expected to be hypotonic in‐vitro and in‐vivo.
Aim
We thus hypothesized that the infusion of gelatin would be expected to decrease plasma osmolality. We performed an in‐vitro experiment and an in‐vivo study to evaluate the impact of gelatin on the osmolality in children.
Methods
In the in‐vitro experiment, full blood samples were diluted with gelatin 4% or albumin (50 g L−1) from 0% (pure blood) to 100% (pure colloid), and the osmolality was measured by freezing‐point depression. In the in‐vivo study, blood gas analyses from children undergoing major pediatric surgery were collected before and after gelatin infusion, and the osmolality was calculated by a modified version of Zander's formula.
Results
In the in‐vitro experiment, 65 gradually diluted blood samples from five volunteers (age 25–55 years) were analyzed. The dilution with gelatin caused no significant changes in osmolality between 0% and 100%. Compared with gelatin, the osmolality in the albumin group was significantly lower between 50% and 100% dilution (p < .05). In the in‐vivo study, 221 children (age 21.4 ± 30 months) were included. After gelatin infusion, the osmolality increased significantly (mean change 4.3 ± 4.8 [95% CI 3.7–4.9] mosmol kg H2O−1; p < .01) within a normal range.
Conclusions
Gelatin in a balanced electrolyte solution has isotonic characteristics in‐vitro and in‐vivo, despite the low theoretical osmolarity, probably caused by the (unmeasured) negative charges in the gelatin molecules contributing to the plasma osmolality. For a better evaluation of the (real) tonicity of gelatin‐containing solutions, we suggest to calculate the osmolality (mosmol kg H2O−1) using Zander's formula.
Trial registration
ClinicalTrials.gov (ID: NCT02495285).</description><identifier>ISSN: 1155-5645</identifier><identifier>EISSN: 1460-9592</identifier><identifier>DOI: 10.1111/pan.14494</identifier><language>eng</language><publisher>Glasgow: Wiley Subscription Services, Inc</publisher><subject>Blood gas analysis ; Electrolytes ; Experiments ; fluid replacement ; gelatin ; Observational studies ; pediatric anesthesia ; Plasma ; plasma osmolality ; real osmolality ; theoretical osmolarity</subject><ispartof>Pediatric anesthesia, 2022-08, Vol.32 (8), p.961-966</ispartof><rights>2022 The Authors. published by John Wiley & Sons Ltd.</rights><rights>2022. This article is published under http://creativecommons.org/licenses/by-nc/4.0/ (the “License”). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c2954-ddc168d8ef04b3e6931d6ece6c4cc40ad168e4430787b2ea3bedb5e74afbe7f83</citedby><cites>FETCH-LOGICAL-c2954-ddc168d8ef04b3e6931d6ece6c4cc40ad168e4430787b2ea3bedb5e74afbe7f83</cites><orcidid>0000-0003-3831-1608 ; 0000-0002-0373-2747 ; 0000-0001-5850-7443</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://onlinelibrary.wiley.com/doi/pdf/10.1111%2Fpan.14494$$EPDF$$P50$$Gwiley$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://onlinelibrary.wiley.com/doi/full/10.1111%2Fpan.14494$$EHTML$$P50$$Gwiley$$Hfree_for_read</linktohtml><link.rule.ids>314,776,780,1411,27901,27902,45550,45551</link.rule.ids></links><search><creatorcontrib>Rudolf, Daniel</creatorcontrib><creatorcontrib>Witt, Lars</creatorcontrib><creatorcontrib>Boethig, Dietmar</creatorcontrib><creatorcontrib>Rigterink, Vanessa</creatorcontrib><creatorcontrib>Zander, Rolf</creatorcontrib><creatorcontrib>Sümpelmann, Robert</creatorcontrib><creatorcontrib>Dennhardt, Nils</creatorcontrib><creatorcontrib>Veyckemans, Francis</creatorcontrib><title>The impact of modified fluid gelatin 4% in a balanced electrolyte solution on plasma osmolality in children—A noninterventional observational study</title><title>Pediatric anesthesia</title><description>Background
Intravenous fluids for perioperative infusion therapy should be isotonic to maintain the body fluid homeostasis in children. Modified fluid gelatin 4% in a balanced electrolyte solution has a theoretical osmolarity of 284 mosmol L−1, and a real osmolality of 264 mosmol kg H2O−1. Because both values are lower than those of 0.9% saline or plasma, gelatin would be expected to be hypotonic in‐vitro and in‐vivo.
Aim
We thus hypothesized that the infusion of gelatin would be expected to decrease plasma osmolality. We performed an in‐vitro experiment and an in‐vivo study to evaluate the impact of gelatin on the osmolality in children.
Methods
In the in‐vitro experiment, full blood samples were diluted with gelatin 4% or albumin (50 g L−1) from 0% (pure blood) to 100% (pure colloid), and the osmolality was measured by freezing‐point depression. In the in‐vivo study, blood gas analyses from children undergoing major pediatric surgery were collected before and after gelatin infusion, and the osmolality was calculated by a modified version of Zander's formula.
Results
In the in‐vitro experiment, 65 gradually diluted blood samples from five volunteers (age 25–55 years) were analyzed. The dilution with gelatin caused no significant changes in osmolality between 0% and 100%. Compared with gelatin, the osmolality in the albumin group was significantly lower between 50% and 100% dilution (p < .05). In the in‐vivo study, 221 children (age 21.4 ± 30 months) were included. After gelatin infusion, the osmolality increased significantly (mean change 4.3 ± 4.8 [95% CI 3.7–4.9] mosmol kg H2O−1; p < .01) within a normal range.
Conclusions
Gelatin in a balanced electrolyte solution has isotonic characteristics in‐vitro and in‐vivo, despite the low theoretical osmolarity, probably caused by the (unmeasured) negative charges in the gelatin molecules contributing to the plasma osmolality. For a better evaluation of the (real) tonicity of gelatin‐containing solutions, we suggest to calculate the osmolality (mosmol kg H2O−1) using Zander's formula.
Trial registration
ClinicalTrials.gov (ID: NCT02495285).</description><subject>Blood gas analysis</subject><subject>Electrolytes</subject><subject>Experiments</subject><subject>fluid replacement</subject><subject>gelatin</subject><subject>Observational studies</subject><subject>pediatric anesthesia</subject><subject>Plasma</subject><subject>plasma osmolality</subject><subject>real osmolality</subject><subject>theoretical osmolarity</subject><issn>1155-5645</issn><issn>1460-9592</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2022</creationdate><recordtype>article</recordtype><sourceid>24P</sourceid><recordid>eNp1kd9K5TAQxou44J_1wjcIiOBe9Ji0SdpeHsRVQdy9cK9Lmkw1kiY1SZXe-RD6gj6JqccrYYcwk2F-35DwZdkhwSuS4nQUdkUobehWtksox3nDmmI73QljOeOU7WR7ITxgTMqCF7vZ2-09ID2MQkbkejQ4pXsNCvVm0grdgRFRW0SPUcoCdcIIK9MYDMjonZkjoODMFLWzKJ3RiDAI5MLgjDA6zotO3mujPNj3l9c1ss5qG8E_gV1EwiDXhdSKry7ESc0_sx-9MAEOvup-9u_3-e3ZZX795-LqbH2dy6JhNFdKEl6rGnpMuxJ4UxLFQQKXVEqKhUpToLTEVV11BYiyA9UxqKjoO6j6utzPTjZ7R-8eJwixHXSQYNIvwU2hLTivqoYUBUvo0Tf0wU0-vXihatZgWlYL9WtDSe9C8NC3o9eD8HNLcLsY1CaD2k-DEnu6YZ-1gfn_YPt3fbNRfAArnpan</recordid><startdate>202208</startdate><enddate>202208</enddate><creator>Rudolf, Daniel</creator><creator>Witt, Lars</creator><creator>Boethig, Dietmar</creator><creator>Rigterink, Vanessa</creator><creator>Zander, Rolf</creator><creator>Sümpelmann, Robert</creator><creator>Dennhardt, Nils</creator><creator>Veyckemans, Francis</creator><general>Wiley Subscription Services, Inc</general><scope>24P</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>K9.</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0003-3831-1608</orcidid><orcidid>https://orcid.org/0000-0002-0373-2747</orcidid><orcidid>https://orcid.org/0000-0001-5850-7443</orcidid></search><sort><creationdate>202208</creationdate><title>The impact of modified fluid gelatin 4% in a balanced electrolyte solution on plasma osmolality in children—A noninterventional observational study</title><author>Rudolf, Daniel ; Witt, Lars ; Boethig, Dietmar ; Rigterink, Vanessa ; Zander, Rolf ; Sümpelmann, Robert ; Dennhardt, Nils ; Veyckemans, Francis</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c2954-ddc168d8ef04b3e6931d6ece6c4cc40ad168e4430787b2ea3bedb5e74afbe7f83</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2022</creationdate><topic>Blood gas analysis</topic><topic>Electrolytes</topic><topic>Experiments</topic><topic>fluid replacement</topic><topic>gelatin</topic><topic>Observational studies</topic><topic>pediatric anesthesia</topic><topic>Plasma</topic><topic>plasma osmolality</topic><topic>real osmolality</topic><topic>theoretical osmolarity</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Rudolf, Daniel</creatorcontrib><creatorcontrib>Witt, Lars</creatorcontrib><creatorcontrib>Boethig, Dietmar</creatorcontrib><creatorcontrib>Rigterink, Vanessa</creatorcontrib><creatorcontrib>Zander, Rolf</creatorcontrib><creatorcontrib>Sümpelmann, Robert</creatorcontrib><creatorcontrib>Dennhardt, Nils</creatorcontrib><creatorcontrib>Veyckemans, Francis</creatorcontrib><collection>Wiley Online Library Open Access</collection><collection>CrossRef</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>MEDLINE - Academic</collection><jtitle>Pediatric anesthesia</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Rudolf, Daniel</au><au>Witt, Lars</au><au>Boethig, Dietmar</au><au>Rigterink, Vanessa</au><au>Zander, Rolf</au><au>Sümpelmann, Robert</au><au>Dennhardt, Nils</au><au>Veyckemans, Francis</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>The impact of modified fluid gelatin 4% in a balanced electrolyte solution on plasma osmolality in children—A noninterventional observational study</atitle><jtitle>Pediatric anesthesia</jtitle><date>2022-08</date><risdate>2022</risdate><volume>32</volume><issue>8</issue><spage>961</spage><epage>966</epage><pages>961-966</pages><issn>1155-5645</issn><eissn>1460-9592</eissn><abstract>Background
Intravenous fluids for perioperative infusion therapy should be isotonic to maintain the body fluid homeostasis in children. Modified fluid gelatin 4% in a balanced electrolyte solution has a theoretical osmolarity of 284 mosmol L−1, and a real osmolality of 264 mosmol kg H2O−1. Because both values are lower than those of 0.9% saline or plasma, gelatin would be expected to be hypotonic in‐vitro and in‐vivo.
Aim
We thus hypothesized that the infusion of gelatin would be expected to decrease plasma osmolality. We performed an in‐vitro experiment and an in‐vivo study to evaluate the impact of gelatin on the osmolality in children.
Methods
In the in‐vitro experiment, full blood samples were diluted with gelatin 4% or albumin (50 g L−1) from 0% (pure blood) to 100% (pure colloid), and the osmolality was measured by freezing‐point depression. In the in‐vivo study, blood gas analyses from children undergoing major pediatric surgery were collected before and after gelatin infusion, and the osmolality was calculated by a modified version of Zander's formula.
Results
In the in‐vitro experiment, 65 gradually diluted blood samples from five volunteers (age 25–55 years) were analyzed. The dilution with gelatin caused no significant changes in osmolality between 0% and 100%. Compared with gelatin, the osmolality in the albumin group was significantly lower between 50% and 100% dilution (p < .05). In the in‐vivo study, 221 children (age 21.4 ± 30 months) were included. After gelatin infusion, the osmolality increased significantly (mean change 4.3 ± 4.8 [95% CI 3.7–4.9] mosmol kg H2O−1; p < .01) within a normal range.
Conclusions
Gelatin in a balanced electrolyte solution has isotonic characteristics in‐vitro and in‐vivo, despite the low theoretical osmolarity, probably caused by the (unmeasured) negative charges in the gelatin molecules contributing to the plasma osmolality. For a better evaluation of the (real) tonicity of gelatin‐containing solutions, we suggest to calculate the osmolality (mosmol kg H2O−1) using Zander's formula.
Trial registration
ClinicalTrials.gov (ID: NCT02495285).</abstract><cop>Glasgow</cop><pub>Wiley Subscription Services, Inc</pub><doi>10.1111/pan.14494</doi><tpages>6</tpages><orcidid>https://orcid.org/0000-0003-3831-1608</orcidid><orcidid>https://orcid.org/0000-0002-0373-2747</orcidid><orcidid>https://orcid.org/0000-0001-5850-7443</orcidid><oa>free_for_read</oa></addata></record> |
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| source | Wiley Online Library Journals Frontfile Complete |
| subjects | Blood gas analysis Electrolytes Experiments fluid replacement gelatin Observational studies pediatric anesthesia Plasma plasma osmolality real osmolality theoretical osmolarity |
| title | The impact of modified fluid gelatin 4% in a balanced electrolyte solution on plasma osmolality in children—A noninterventional observational study |
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