High Strong Ion Difference Fluid vs Hartmann's Solution on Acid-Base Status in Sepsis

A Double-Blind, Randomized Control Trial of Rapidly Infused High Strong Ion Difference Fluid Versus Hartmann's Solution on Acid-Base Status in Sepsis and Septic Shock Patients in the Emergency Department Hospital Pulau Pinang

This is a research to study primarily the effect of rapidly infused high strong ion difference (SID) fluid vs Hartmann's solution in altering the pH and bicarbonate level of the patient, who is in sepsis with metabolic acidosis. Half of the study population gets high SID fluid, while the other half will get Hartmann's solution.

Balanced fluids are preferred in initial resuscitation of septic patients based on several recent studies.

The Stewart's concept on acid-base balance predicts that high strong ion difference (SID) fluid thus will increase the pH level.

High SID fluid are specially formulated by adding sodium bicarbonate into half saline solution, the resultant fluid contains sodium= 145mmol/L and chloride=70mmol/L (SID= 75) as compared to Hartmann's solution with the SID of 20.

Inclusion Criteria:

• age≥18 years
• fulfills 2/3 qSOFA criteria
• presumed infection
• a blood pH at presentation ≤ 7.35
• hyperlactatemia (blood lactate level, >2mmol/L )

Exclusion Criteria:

• existing cardiac failure, major cardiac arrhythmia, advanced chronic kidney disease or end stage failure
• known pregnancy
• suspected dengue
• primary diagnosis is related to burn, trauma, or drug overdose
• if more than 500cc of resuscitation fluid was administered before enrollment.