A COMPARATIVE STUDY OF PLASMA-LYTE A VERSUS 0.9% NORMAL SALINE FOR PERIOPERATIVE FLUID RESUSCITATION IN EMERGENCY LAPAROTOMY FOR GASTROINTESTINAL PERFORATION

Abstract

Background:
Gastrointestinal (GI) perforation is a surgical emergency commonly associated with hypovolemia, sepsis, and significant electrolyte disturbances. Effective fluid resuscitation is critical to optimizing outcomes in such patients. While 0.9% normal saline (NS) is traditionally used, its high chloride content has been linked to hyperchloremic metabolic acidosis, acute kidney injury, and increased morbidity [1,2]. Balanced crystalloids such as Plasma-Lyte A, with a composition closer to plasma and a near-physiologic pH, may offer clinical advantages [3].

Objective:To compare the efficacy of Plasma-Lyte A and 0.9% NS in maintaining acid-base balance, renal function, and fluid status in patients undergoing emergency laparotomy for gastrointestinal perforation.

Methods:
In this prospective, randomized controlled study, 30 adult patients aged 18–65 years, undergoing emergency laparotomy for gastrointestinal perforation, were enrolled and randomly assigned into two groups. Group A (n = 15) received Plasma-Lyte A, and Group B (n = 15) received 0.9% NS for perioperative fluid resuscitation. Patients with pre-existing renal disease, chronic liver disease, or electrolyte imbalances were excluded. Standard general anesthesia and monitoring protocols were followed. Arterial blood gas (ABG), serum electrolytes, serum creatinine, and urine output were measured preoperatively and at 6 hours postoperatively. Statistical analysis was performed using the Chi-square test, with significance set at p < 0.05.

Results:At 6 hours postoperatively, Group A exhibited significantly higher mean pH (7.38 ± 0.04 vs. 7.31 ± 0.05; p < 0.05), lower serum chloride levels (104 ± 3 vs. 110 ± 4 mmol/L; p < 0.01), and less negative base excess (-1.2 ± 0.5 vs. -4.8 ± 0.8; p < 0.01) compared to Group B. Serum creatinine was lower in Group A (1.0 ± 0.2 vs. 1.3 ± 0.3 mg/dL; p = 0.04), and urine output was higher (55 ± 10 vs. 40 ± 12 ml/hr; p = 0.03).

Conclusion:Plasma-Lyte A demonstrated superior maintenance of acid-base balance and renal function compared to 0.9% normal saline in patients undergoing emergency laparotomy for gastrointestinal perforation. The use of balanced crystalloids may reduce metabolic complications and improve early postoperative outcomes in this high-risk population.