Metabolic effects of plasma expanders: METABOLIC EFFECTS OF PLASMA EXPANDERS

SUMMARY All plasma expanders exert metabolic effects – either favorable effects such as correction of hypovolemia-induced lactic acidosis or renal failure, or unwanted adverse effects such as hypotonic solution-induced hyponatremia, acid-base disorders such as hyperchloremic acidosis and effects related to buffers associated with plasma expanders (lactate, acetate). The use of crystalloids alone is associated with a risk of interstitial fluid overload responsible for organ dysfunction in anesthesia and intensive care. The exclusive and prolonged use of high doses of colloids is associated with a risk of severe renal failure. Crystalloids appear to be sufficient to correct tissue hypoperfusion induced by moderate hypovolemia. Alternating prescription of isotonic saline and balanced plasma expanders should be able to avoid the metabolic complications of these two types of crystalloids. Administration of colloids is safe when the recommended maximum doses are observed. When administration of a colloid is indicated, a latest generation hydroxyethyl starch solution appears to present the best benefit/risk ratio.