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Critical Care

, 17:R104

First Online: 29 May 2013Received: 01 December 2012Revised: 23 March 2013Accepted: 29 May 2013


IntroductionThe turnover of Ringers solutions is greatly dependent on the physiological situation, such as the presence of dehydration or anaesthesia. The present study evaluates whether the kinetics is affected by previous infusion of colloid fluid.

MethodsTen male volunteers with a mean age of 22 years underwent three infusion experiments, on separate days and in random order. The experiments included 10 mL-kg of 6% hydroxyethyl starch 130-0.4 Voluven™, 20 mL-kg of Ringer-s acetate, and a combination of both, where Ringers was administered 75 minutes after the starch infusion ended. The kinetics of the volume expansion was analysed by non-linear least- squares regression, based on urinary excretion and serial measurement of blood haemoglobin concentration for up to 420 minutes.

ResultsThe mean volume of distribution of the starch was 3.12 L which agreed well with the plasma volume 3.14 L estimated by anthropometry. The volume expansion following the infusion of starch showed monoexponential elimination kinetics with a half-life of two hours. Two interaction effects were found when Ringers acetate was infused after the starch. First, there was a higher tendency for Ringers acetate to distribute to a peripheral compartment at the expense of the plasma volume expansion. The translocated amount of Ringers was 70% higher when HES had been infused earlier. Second, the elimination half-life of Ringers acetate was five times longer when administered after the starch 88 versus 497 minutes, P <0.02.

ConclusionsStarch promoted peripheral accumulation of the later infused Ringers acetate solution and markedly prolonged the elimination half-life.

Trial NCT01195025

Keywordspharmacokinetic model i.v. fluids, hydroxyethyl starch AbbreviationsAUCarea under the curve

COPcolloid osmotic pressure



HEShydroxyethyl starch

kofluid loss by evaporation through skin and airways

k10rate constant for fluid leaving the system

k12rate constant for fluid passing from vc to vp

k21rate constant for fluid passing from vp to vc

Rorate of infusion


Electronic supplementary materialThe online version of this article doi:10.1186-cc12749 contains supplementary material, which is available to authorized users.

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Autor: Robert G Hahn - Christian Bergek - Tobias Gebäck - Joachim Zdolsek


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