Kwasica metaboliczna i klinicznie istotne zaburzenia równowagi wodno-elektrolitowej po szybkim przetoczeniu dużej objętości 6% roztworu hydroksyetylowanej skrobi u dziecka – opis przypadku

*Bogumiła Wołoszczuk-Gębicka¹, Janusz Świetliński², Marcin Roszkowski³, Paweł Daszkiewicz³

Summary
Background. Brain tumour surgery may be associated with major blood loss, especially dangerous in children due to the small volume of circulating blood.
Case report. A 2.5 year old, 14.5 kg boy was scheduled for brain tumour resection. During the tumour resection massive bleeding, lasting approximately one hour, occurred. Estimated blood loss exceeded 1500 ml. This was replaced with 750 ml of the isotonic balanced electrolyte solution, 750 ml of 6% hydroxyethyl starch (HES) and 100 ml of 5% human albumin. 750 ml RBC transfusion was necessary to maintain haematocrit between 24 and 30%. Subsequently, rapidly progressing hyperchloremia, metabolic acidosis and hypokalemia with slightly elevated lactate concentration developed. Metabolic disturbances resolved within 36 hour, except for an increased anion gap.
Discussion. Replacement of the circulating blood volume with HES solutions is more effective that with crystalloids, due to their longer stay in the vascular bed. Unfortunately, HES is diluted in the 0.9% saline solution and massive transfusion may lead to hyperchloremia and metabolic acidosis, as happened in the reported case. We conclude that massive and rapid infusion of HES may be used in the life threatening situations only, and frequent assessment of serum electrolytes and blood gas analysis is mandatory.

To jest tylko fragment artykułu. Aby przeczytać całość, przejdź do Czytelni medycznej.