Chloride concentration of IV albumin solutions available at Canadian hospitals.
CCCF ePoster library. Millen T. Oct 27, 2015; 117324; P82 Disclosure(s): I have no disclosures.
Tina Millen
Tina Millen
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Abstract
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P82


Topic: Basic/Translational Science


Chloride concentration of IV albumin solutions available at Canadian hospitals.



Tina Millen, M. Zeller, P. Kavsak, G. Guyatt, R. Jaeschke, F. Lamontagne, T. Karachi, D. Cook, M. Meade

Medicine (Critical Care), Clinical Epidemiology & Biostatistics, McMaster University, Hamilton, Canada | Medicine, McMaster University, Hamilton, Canada | Pathology, McMaster University, Hamilton, Canada | Medicine, Clinical Epidemiology & Biostatistics, McMaster University, Hamilton, Canada | Medicine, McMaster University, Hamilton, Canada | Medicine, University of Sherbrooke, Sherbrooke, Canada | Medicine, McMaster University, Hamilton, Canada | Medicine, Clinical Epidemiology & Biostatistics, McMaster University, Hamilton, Canada | Medicine, Clinical Epidemiology & Biostatistics, McMaster University, Hamilton, Canada

Introduction: Emerging evidence suggests that hyperchloremic resuscitation fluids can be harmful to critically ill patients,1 with observational studies suggesting increased risk of AKI2 or death3. Current research in this area has focused on the chloride content of crystalloid solutions and the potential harm of high chloride 0.9% normal saline. Despite the widespread use of intravenous albumin in Canada (99,218 units of 5% albumin administered in 2014), the chloride concentration of various albumin products available for clinical use remains obscure. Three separate manufacturers supply 5% albumin solutions through Canada Blood Services: Grifols (Plasbumin), CSL Behring (Alburex), and Octapharma (Octalbin) and all three are used routinely for patient administration.

Objectives: To test the chloride concentration of widely available albumin solutions for use in critical illness in Canada.

Methods: Albumin samples were obtained from the Hamilton Health Sciences blood bank stores. We tested two bottles from each of two different batches of albumin products, for a total of four bottles from each manufacturer. The products were tested by on an automated platform and treated identical to patient samples. The lab technician was unblinded to albumin product however was unaware of the reason for electrolyte testing or the underlying hypothesis. The chloride concentration was measured via an indirect ion-selective electrode on the Abbott ARCHITECT c8000 chemistry analyzer4. The analytical range of this analyzer, as provided by the manufacturer, is 50 to 150 mmol/L for serum/plasma and 20 to 300 mmol/L for urine, with imprecision less than 2%.

Results:

Albumin Product

Manufacturer

Mean Chloride Concentration in mmol/L (SD)

Range of Chloride Concentration over four tests

5% Plasbumin

Grifols

110.73 (0.6)

110.2-111.5

5% Alburex

CSL Behring

122.2 (0.6)

121.8-122.6

5% Octalbin

Octapharma

137.4 (0.5)

137.0-137.7



Conclusion:

Significant variability in chloride concentration between available 5% albumin products was observed. There does not seem to be a large degree of sample-to-sample or batch-to-batch variation within individual products and in fact the variation observed could be explained by the test imprecision alone. The Grifols product had the lowest chloride concentration and most closely resembled that of a balanced crystalloid such as Ringer’s Lactate (which has a chloride concentration of 110 mEq/L). The Octapharma product had the highest concentration most closely resembling that of 0.9% normal saline (chloride concentration 154 mEq/L). Further studies are required to investigate the effect of administering albumin products with varying chloride content on patient-important outcomes in the ICU.



References:

1. Yunos NM, Bellomo R, Story D, Kellum J. Bench-to-bedside review: Chloride in critical illness. Critical care (London, England). 2010;14(4):226.

2. Yunos NM, Bellomo R, Hegarty C, Story D, Ho L, Bailey M. Association between a chloride-liberal vs chloride-restrictive intravenous fluid administration strategy and kidney injury in critically ill adults. JAMA : the journal of the American Medical Association. Oct 17 2012;308(15):1566-1572.

3. Neyra JA, Canepa-Escaro F, Li X, et al. Association of Hyperchloremia With Hospital Mortality in Critically Ill Septic Patients. Critical care medicine. Sep 2015;43(9):1938-1944.

4. Diagnostics A. 2015; https://http://www.abbottdiagnostics.com/en-us/products/ARCHITECT-c8000.html. Accessed September 1, 2015.

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