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

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