The authors showed similar fluid requirements with 3% tetrastarch (in balanced solvent) and unbalanced crystalloid in 40 patients undergoing a standardised surgical procedure, primary hip replacement, with only moderate bleeding. Plasma chloride concentration was higher in patients exposed to the unbalanced solution resulting in a lower standard base excess. Together, these findings are in line with existing understanding of context-sensitive volume efficacy of 3% tetrastarch and the induction of hyperchloraemic metabolic acidosis by unbalanced salt infusion.

– Sibylle Kozek-Langenecker