Huah Chiang Ooi Chun Chiat Yeoh Aik Howe Teo Abdul Muhaimin Noor Azhar Sherene Tan Ying Ying Thum Kwanhathai Darin Wong Sasi Kumar Sappanie


Background: 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. To date, the impact of high SID fluid in septic patient with metabolic acidosis remains uncertain. We conducted a single center, randomized, double-blind trial to compare the effect of High-SID fluid vs Hartmann’s solution on acid-base status in selected sepsis patients in the Emergency Department.

Method: Septic patient with hyperlactatemia and metabolic acidosis were randomized to receive either High-SID fluid or Hartmann’s solution during initial fluid resuscitation. The primary outcome measures the pH and bicarbonate levels difference pre- and post-resuscitation.

Results: 162 patients underwent randomization, 81 were assigned each to receive High-SID fluid or Hartmann’s solution. Both groups had similar baseline characteristics. High-SID group received 23.5ml/kg and the Hartmann’s group received 22.7ml/kg (p=0.360). High-SID fluid increased the mean(±SD) pH by 0.107(±0.09) vs Hartmann’s solution by 0.014(±0.12), p=<0.001. Mean bicarbonate level increased significantly in High-SID group compared to Hartmann’s (4.30±3.76 vs 1.25±3.33; p=<0.001). High-SID group had higher post resuscitation lactate clearance than Hartmann’s group (25.4±28.3% vs 12±34.1%;p=0.009). Shorter hospital stay was observed in high-SID group 8.04±5.96days vs Hartmann’s group 12.18±12.41days (p=0.048). Both groups showed no difference in incidence of pulmonary oedema, acute kidney injury and mortality.

Conclusion: Initial resuscitation using high SID fluid in selected septic patient improves pH and bicarbonate levels. The High-SID group had better post resuscitation lactate clearance and shorter hospital stay.



Strong Ion Difference, Sepsis, Fluid Resuscitation, Hyperlactataemia, Metabolic Acidosis, Septic Shock, Acid-Base, Randomised Control Trial, Hartmann Solution, pH, Crystalloid

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