The Effect Of Intraoperative Co-Administration Of Ringers Lactate Combined With 0.9% Normal Saline On Serum Electrolytes And Lactate In Patients Undergoing Elective Craniotomy

Abstract

Background Intravenous fluids are used in virtually all surgical specialties for fluid maintenance. The most common fluids used are 0.9% Normal Saline and Ringers Lactate. In the neurosurgical patients, the osmotic force exerted by the electrolytes sodium and chloride have a key role in the movement of fluid across the brain capillaries. Normal Saline used as monotherapy has been shown to cause metabolic acidosis and arrhythmias when infused in large amounts, thus co-administration with ringers lactate ameliorates these potential side effects. Objectives The objective of this study was to describe the effect of co administered ringers lactate and 0.9% normal saline on serum sodium, potassium, chloride and lactate levels in neurosurgical patients undergoing elective craniotomy. Study Design and Methods This was a descriptive cross sectional study carried out in Kenyatta National Hospital, neurosurgical theatres. Data was collected from the anaesthesia chart on type and amount of intravenous fluid used, acid base balance from the blood gas analysis strip done hourly were recorded on the data collection sheet. The sample size was 71 patients scheduled for elective craniotomy meeting the inclusion criteria. All the data collected in the study was sorted, coded and entered in a computer using SPSS Version 21. T- tests were used to compare mean changes in serum sodium, potassium, chloride and lactate to the crystalloid infused and Chi-square tests were used to compare proportions. Findings: There was a marginal reduction in serum sodium with infusion of combined crystalloids, within a normal safety margin. Serum potassium and lactate steadily increased xiv every hour with infusion of crystalloids with no correlation to blood loss. Serum chloride marginally increased from the 2nd to 3rd hour and stabilized at the 4th hour. No correlation was seen to with blood loss. Conclusion: Both N/S and R/L are safe crystalloids to infuse in combination therapy in elective craniotomy patients.