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J Surg Res. 2018 Dec;232:605-613. doi: 10.1016/j.jss.2018.07.017. Epub 2018 Aug 9.

The Liver and Small Intestine Can Partly Compensate Severe Normovolemic Hemodilution in a Rat Model.

Author information

1
University of Duisburg-Essen, Institute of Physiological Chemistry, University Hospital Essen, Essen, Germany. Electronic address: indra.waack@uk-essen.de.
2
Ambulatory Healthcare Center Dr. Eberhard & Partner Dortmund, Dortmund, Germany.
3
University of Duisburg-Essen, Institute of Physiological Chemistry, University Hospital Essen, Essen, Germany.

Abstract

BACKGROUND:

Knowing the individual critical hematocrit for every organ is essential in operative scenarios in which extensive blood losses are expected. In the past, experimental settings were very heterogeneous resulting in the publication of widely differing values even for one organ in the same species. This study aimed to investigate the compensatory capacity of the liver and the small intestine in a rat model of severe normovolemic hemodilution.

MATERIALS AND METHODS:

Male rats were subjected to a stepwise hemodilution with a succinylated gelatin-containing solution to a final hematocrit of 10%, being observed for additional 150 min. During the course of the experiment, blood glucose and L-lactate, as well as D-lactate and intestinal fatty acid-binding protein-2 measurements, were performed eight times in total. The amino acids alanine and glutamine were measured during dilution and at the end of the experiment (four times in total). Hemodilutional effects on the blood and oxygen supply of the liver and the small intestine were measured in a minimally invasive manner.

RESULTS:

In the liver and the small intestine, there were no substantial changes in the blood flow of the microcirculation. Plasma glucose and lactate levels rose transiently, whereas lactate values did not exceed the upper threshold of aerobic metabolism. Plasma levels of the amino acids alanine and glutamine rose significantly and stayed elevated, whereas D-lactate and intestinal fatty acid-binding protein-2 were not significantly increased at any point during the whole experimental time compared to the initial value.

CONCLUSIONS:

Severe hemodilution with a succinylated gelatin-containing solution is tolerated at a profoundly low hematocrit value of 10% during the experimental phase of 150 min.

KEYWORDS:

Compensation; Critical hematocrit; Hemodilution; Liver; Small intestine

PMID:
30463780
DOI:
10.1016/j.jss.2018.07.017

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