Change of Lactate Concentration During Hartmann Solution Infusion for Hepatic Resection

The liver is important in acid-base physiology and electrolyte balance. It is important because it is a metabolically active organ which may be either a significant net producer or consumer of hydrogen ions.

Lactate is produced in the peripheral tissues such as the muscles, skin, brain, and red blood cells and it is metabolized predominantly in the liver and kidneys, first to pyruvate and secondly to glucose. In the healthy liver, there is a net-uptake of lactate caused by gluconeogenesis, and the liver exhibits a higher net lactate clearance than any other organ anticipated to be up to 70% of the whole body clearance. Lactic acidosis will result if this hepatic metabolism is not adequate.

Hartmann's solution, which contains 28 mmol/l of lactate and has a pH of 6.5, has been extensively used to maintain and replace intravascular volume in a variety of anesthetic procedures. Excessive use of saline has been observed to result in hyperchloraemic acidosis - which has been identified as a potential side effect of saline based solutions. It has been suggested that the use of balanced electrolyte solutions may avoid this effect.

A previous study concerned that normal saline, which does not contain lactate, might be detrimental to liver donors because of an association with hyperchloremic metabolic acidosis.

Metabolism of lactate sourced from IV Hartmann's solution also results in a net consumption of H+, but as this lactate was associated with Na+, the overall result is a net bicarbonate production. Effectively, metabolism of this lactate results in generation of an equivalent amount of bicarbonate. The investigators are evaluating about the metabolism of lactate sourced from IV Hartmann's solution in patients with HCC and donor for liver transplantation (control group).