Acid-Base Balance according to Intravenous Fluid during Continuous Hyperthermic Peritoneal Perfusion

Jeon, Joon Pyo; Na, Ai Ja; Choi, Jong Ho; Kim, Sung Nyeun

Abstract

BACKGROUND: Continuous hyperthermic peritoneal perfusion (CHPP) has been introduced to improve the survival of cancer patients. However CHPP induced acute change of body temperature and intra- abdominal pressure could produce various abnormal physiologic responses, especially acid-base and electrolyte imbalance. The purpose of this study was to evaluate the effects of intravenous fluids, plasma solution and Hartmann's solution on acid-base status and electrolyte concentrations during CHPP and to determine strategies for safer fluid management.
METHODS
Thirty five patients with ovarian cancer were divided into two groups; Group 1 (16 patients) was supplied with plasma solution and Group 2 (19 patients) was supplied with a Hartman solution as the intravenous fluid. Closed peritoneal irrigation was done with perfusate at a temperature of 47oC for 90 min under general anesthesia. Body temperature, hemodynamic parameters (mean arterial pressure MAP, heart rate HR), blood gas tensions (PaO2, PaCO2), acid-base parameters (pH, base deficit BD) and electrolytes (sodium, potassium, calcium) were measured at 10 min before CHPP, 30, 60, 90 min after the initiation of CHPP, and 30 min after the end of CHPP.
RESULTS
There were no significant changes in body temperature, MAP, HR, PaO2, PaCO2 during CHPP in both groups. pH measured at postCHPP in group 2 was significantly lower than that measured in group 1. Base deficits measured at 30, 60, 90 min after the initiation of CHPP and 30 min after the end of CHPP in group 2 were significantly lower than those measured in group 1. Potassium and calcium ion concentations did not show statistical significance during CHPP in both groups. 7 patients in group 1 whose calcium ion level dropped by more than 20% of the initial value needed a calcium injection but only 1 patient in group 2 needed a calcium injection.
CONCLUSION
It appears that hemodynamic stability was maintained well during CHPP between the two group. A plasma solution may be more ideal in reducing acidic tendencies and base deficits thana Hartmann's solution but a plasma solution supplied group requires frequent evaluation and a supply of calcium for adequate serum calcium levels.