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A comparison of the effects of four intravenous solutions for the treatment of ketonuria during labour
Author(s) -
MORTON K. E.,
JACKSON M. C.,
GILLMER M. D. G.
Publication year - 1985
Publication title -
bjog: an international journal of obstetrics and gynaecology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.157
H-Index - 164
eISSN - 1471-0528
pISSN - 1470-0328
DOI - 10.1111/j.1471-0528.1985.tb01351.x
Subject(s) - ketonuria , saline , medicine , anesthesia , whole blood , insulin
Summary. Forty women in whom ketonuria was detected during the first stage of labour were allocated randomly to intravenous treatment with one litre of either normal saline. Hartmann's solution, 5% dextrose or 10% dextrose. The solutions were administered over 1 h and blood was taken immediately beforehand and thereafter at 30‐min intervals for 90 min to assess their effect on intermediary metabolism, plasma osmolality and acid‐base status. Although both the 5 and 10% dextrose infusions caused a rapid decline in whole blood d‐3‐hydroxybutyrate concentrations, they also produced pathological degrees of maternal hyperglycaemia and hyperinsulinaemia and a marked elevation in the mean blood lactate and pyruvate concentrations. Administration of 10% dextrose was also associated with a significant increase in serum osmolality. Hartmann's solution produced significantly higher mean whole blood lactate and pyruvate concentrations than did normal saline. There was a significant increase in the venous base deficit in the group infused with 10% dextrose, indicating that the buffering capacity of the blood had been exceeded. It is concluded that rapid infusions of dextrose or Hartmann's solution should not be administered during labour. Normal saline should be used for rehydration and if dextrose therapy is deemed necessary the dose administered should not exceed physiological requirements.