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

Abstract

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&#x2009;mL/kg/h for 4&#x2009;h, based on their volume status. H-SID was compounded with sodium (145&#x2009;mmol/L), lactate (145&#x2009;mmol/L), potassium (10&#x2009;mmol/L), and aspartate (10&#x2009;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&#x2009;mL/kg/h (p&#x2009;<&#x2009;0.001) and 10&#x2009;mL/kg/h (p&#x2009;<&#x2009;0.001) when compared to the RL group. At the lower infusion rate, the median increase was 4.1&#x2009;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&#x2009;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.