INTRAVENOUS PHYSIOLOGICAL SOLUTION TO OPTIMIZE FLUID THERAPY IN PATIENTS

Abstract

An intravenous fluid composition includes sodium chloride and sodium acetate that can provide appropriate sodium load and osmolality, with chloride concentration and pH mimicking normal values in human blood.

Claims

1. A method for preparing a pharmacological solution for intravenous administration, the method comprising the steps of: mixing sodium chloride and sodium acetate in distilled water at 40-60° C. to obtain a solution; filling the solution, while at 40-60° C., in a packaging bag; and cooling down the solution to room temperature in the packaging bag.

2. The method according to claim 1, wherein 4500-7000 mg of sodium chloride and 2250-4500 mg of sodium acetate are mixed in 1 Liter of distilled water.

3. The method according to claim 2, wherein about 300 mg of potassium acetate is also added, wherein the solution has a theoretical osmolality of 300-310 mmol/l.

4. An intravenous fluid composition consisting essentially of 4500-7000 mg of sodium chloride, 2250-4500 mg of sodium acetate, and a pre-determined amount of potassium acetate in 1 Liter of distilled water, wherein the intravenous fluid composition has a calculated osmolality of about 292-310 mmol/l.

5. The intravenous fluid composition according to claim 4, wherein the predetermined amount of potassium acetate is about 300 mg.

6. The intravenous fluid composition according to claim 4, wherein the sodium chloride is present in an amount of about 6000 mg or 205 mmol/l, and sodium acetate is present in an amount of about 4000 mg or 97.5 mmol/l, wherein the intravenous fluid composition has a calculated osmolality of about 302.5 mmol/l to 308.5 mmol/l and a pH of about 7.

7. The intravenous fluid composition according to claim 5, wherein the sodium chloride is present in an amount of about 6000-7000 mg and sodium acetate is present in an amount of about 3500-4000 mg, wherein the intravenous fluid composition has a calculated osmolality of about 310 mmol/l and a pH of about 7.

Description

DETAILED DESCRIPTION

[0014] Subject matter will now be described more fully hereinafter. Subject matter may, however, be embodied in a variety of different forms and, therefore, covered or claimed subject matter is intended to be construed as not being limited to any exemplary embodiments set forth herein; exemplary embodiments are provided merely to be illustrative. Likewise, a reasonably broad scope for claimed or covered subject matter is intended. Among other things, for example, the subject matter may be embodied as methods, devices, components, or systems. The following detailed description is, therefore, not intended to be taken in a limiting sense.

[0015] The word “exemplary” is used herein to mean “serving as an example, instance, or illustration.” Any embodiment described herein as “exemplary” is not necessarily to be construed as preferred or advantageous over other embodiments. Likewise, the term “embodiments of the present invention” does not require that all embodiments of the invention include the discussed feature, advantage, or mode of operation.

[0016] The terminology used herein is for the purpose of describing particular embodiments only and is not intended to be limiting of embodiments of the invention. As used herein, the singular forms “a”, “an” and “the” are intended to include the plural forms as well, unless the context clearly indicates otherwise. It will be further understood that the terms “comprises”, “comprising,”, “includes” and/or “including”, when used herein, specify the presence of stated features, integers, steps, operations, elements, and/or components, but do not preclude the presence or addition of one or more other features, integers, steps, operations, elements, components, and/or groups thereof.

[0017] The following detailed description includes the best currently contemplated mode or modes of carrying out exemplary embodiments of the invention. The description is not to be taken in a limiting sense but is made merely for the purpose of illustrating the general principles of the invention, since the scope of the invention will be best defined by the allowed claims of any resulting patent.

[0018] In one aspect, disclosed is a saline intravenous fluid composition that includes sodium chloride and sodium acetate in pre-determined concentration in the distilled water. The disclosed intravenous fluid composition includes high sodium content and comparatively low chloride content thus can maintain desired osmotic gradient. The desired osmotic gradient can be such that to pull water from the brain through the blood brain barrier into the serum to prevent and treat cerebral edema and high intracranial pressure.

[0019] Also, disclosed is a method of preparing the intravenous fluid composition by mixing sodium chloride and sodium acetate in distilled water at 40-60° C., and more preferably at 40° C. to obtain a solution. The solution can be filled in packaging bags while hot and allowed to cool to room temperature in the packaging bag. The resulting intravenous fluid composition can have the pH of about 7 and the pH can be maintained for a long period.

Experiment 1

[0020] A study was conducted in which the data of patients with spontaneous ICH within 4.5 hours of symptom onset were analyzed. Patients with an increased serum chloride (110 mmol/L or greater) at either baseline, or 24, 48, or 72 hours after randomization were identified. Among the total of 1000 patients analyzed, one and two or more occurrences of hyperchloremia within 72 hours were seen in 114 patients and 154 patients, respectively. Compared with patients without hyperchloremia, patients with one occurrence of hyperchloremia (odds ratio [OR] 2.5, 95% confidence interval [CI] 1.1-5.6), and those with two or more occurrences (OR 2.6, 95% CI 1.3-5.0) at significantly higher odds of death within 90 days after adjustment for age, race/ethnicity, National Institutes of Health Stroke Scale (NIHSS) score strata, hematoma volume, presence or absence of intraventricular hemorrhage, cigarette smoking, and previous stroke. Compared with patients without hyperchloremia, patients with two or more occurrences (OR 3.5, 95% CI 2.1-5.7) at significantly higher odds of death or disability at 90 days.

Experiment 2

[0021] In another study was analyzed the data from Albumin in Acute Ischemic Stroke (ALIAS) Part 1 and 2 trials recruited patients with acute ischemic stroke within 5 hours of symptom onset. Patients with an increased serum chloride (110 mmol/L or greater) at either baseline, or 24, or 48 hours after randomization were identified. We further graded hyperchloremia into one occurrence or two or more occurrences within the first 48 hours. Among the total of 1275 patients analyzed, one and two or more occurrences of hyperchloremia within 48 hours were seen in 191 patients and 108 patients, respectively. Compared with patients without hyperchloremia, patients with two or more occurrences of hyperchloremia (OR 3.0, 95% CI 1.8-5.0) at significantly higher odds of non-favorable outcomes within 90 days after adjustment for age, NIHSS score strata, initial systolic blood pressure, and treatment group (albumin or placebo). Compared with patients without hyperchloremia, patients with two or more occurrences of hyperchloremia at non-significantly higher odds of death within 90 days after adjusting for potential confounders. Patients with one occurrence of hyperchloremia were not at higher odds for non-favorable outcomes at 90 days.

Experiment 3: Preparation of the Disclosed Intravenous Fluid Composition

[0022] 1 L of distilled water was heated up to 40° C. under a pressure of about 25 atmospheres. Thereafter, 6000 mg of sodium chloride, 4000 mg of sodium acetate, and optionally 300 mg potassium acetate were mixed, while maintaining the pressure, in the water to obtain a solution. The solution while hot was filled in a packaging bag. The solution in the packaging bag was allowed to cool to room temperature. The solution contains sodium chloride 205 mmol, sodium acetate 97.5 mmol, and potassium acetate 6 mmol with a theoretical osmolality of 302.5 mmol/L to 308.5 mmol/L and pH of approximately 7.

TABLE-US-00001 TABLE 1 Comparison of disclosed fluid composition with existing saline compositions (mmol/L). Na K Mg Ca Chloride Acetate Gluconate Lactate Malate Plasma 136-145 3.5-5.0 0.8-1.0 2.2-2.6 98-106 Nil Nil Nil Nil Sodium chloride 154 Nil Nil Nil 154 Nil Nil Nil Nil (0.9%) Compound sodium 129 5 Nil 2 109 Nil Nil 29 Nil Lactate (lactate buffered) Ringer's lactate 130 4 Nil 3 109 Nil Nil 28 Nil (lactate buffered) Ionosteril ® 137 4 1.25 1.65 110 36.8 Nil Nil Nil (acetate buffered solution) Sterofundin ISO ® 145 4 1 2.5 127 24 Nil Nil 5 (acetate and malate buffered) Plasma-Lyte 148 ® 140 5 1.5 Nil 98-106 27 23 Nil Nil (acetate and gluconate buffered) Disclosed composition 150 5 Nil Nil 100 50 Nil Nil Nil

TABLE-US-00002 TABLE 2 Comparison of Osmolality and pH of proposed fluid with existing fluids. Actual or Theoretical measured osmolarity osmolality (mOsmol/kg) (mOsmol/kg) pH Plasma 291 287 7.35-7.45 Sodium chloride (0.9%) 308 286 4.5-7   Compound sodium Lactate 28 278 5-7 (lactate buffered) Ringer's lactate (lactate 278 256 5-7 buffered) lonosteril ® (acetate 291  20 6.9-7.9 buffered solution) Sterofundin ISO ® (acetate 309 Not stated 5.1-5.9 and malate buffered) Plasma-Lyte 148 ® (acetate 295 .sup. 271.sup.b 7.4.sup.c and gluconate buffered) Disclosed composition 300-310 Not measured 7.0-7.4

[0023] In one exemplary embodiment, disclosed is an intravenous fluid composition comprising 4500-7000 mg of sodium chloride, and 2250-4500 mg of sodium acetate, and 300 mg of potassium acetate in 1 Liter of distilled water, wherein the solution has a calculated osmolality of 300-310 mmol/L.

[0024] In a preferred embodiment, the disclosed intravenous fluid composition can be prepared from 6000 mg of sodium chloride, and 3000 mg of sodium acetate in 1 Liter of distilled water. The solution contains sodium chloride 205 mmol and sodium acetate 71.5 mmol with a calculated osmolality of 276 mmol/L and pH of approximately 7.

[0025] In a preferred embodiment, the disclosed intravenous fluid composition can be prepared from 6000 mg of sodium chloride, and 4000 mg of sodium acetate, with or without 300 mg potassium acetate in 1 Liter of distilled water. The solution contains sodium chloride 205 mmol and sodium acetate 97.5 mmol with potassium acetate 6 mmol with a calculated osmolality of 302.5 mmol/L to 308.5 mmol/L and pH of approximately 7.

[0026] In a preferred embodiment, the disclosed intravenous fluid composition can be prepared from 6750 mg of sodium chloride, and 2250 mg of sodium acetate, with or without 300 mg potassium acetate in 1 Liter of distilled water. The solution contains sodium chloride 231 mmol, sodium acetate 54.9 mmol, and potassium acetate 6 mmol with a calculated osmolality of 292 mmol/L and pH of approximately 7.

[0027] In a preferred embodiment, the disclosed intravenous fluid composition can be prepared from 4500 mg of sodium chloride, and 4500 mg of sodium acetate, with or without 300 mg potassium acetate in 1 Liter of distilled water. The solution contains sodium chloride 153.8 mmol, sodium acetate 109.7 mmol, and potassium acetate 6 mmol with a calculated osmolality of 269.5 mmol/L and pH of approximately 7.

[0028] In a preferred embodiment, the disclosed intravenous fluid composition can be prepared from 6000-7000 mg of sodium chloride, and 3500-4000 mg of sodium acetate, and 300 mg of potassium acetate in 1 Liter of distilled water to increase the calculated osmolality of greater than 310 mmol/L.

[0029] In one exemplary embodiment, the disclosed composition can be prepared from sodium chloride and a second salt selected from sodium diacetate or sodium bicarbonate.

[0030] While the foregoing written description of the invention enables one of ordinary skill to make and use what is considered presently to be the best mode thereof, those of ordinary skill will understand and appreciate the existence of variations, combinations, and equivalents of the specific embodiment, method, and examples herein. The invention should therefore not be limited by the above-described embodiment, method, and examples, but by all embodiments and methods within the scope and spirit of the invention as claimed.