Overview of the effects of Ringer's acetate solution and a new concept: Renal ketogenesis during hepatic inflow occlusion

Developments in infusion therapy with sodium lactate administered with its isomer, and developments in acetate utilization, both as an infusate or a dialysate, have been previously described, as have the various effects of sodium acetate on cardiovascular function, metabolism and fluid replacement. Unfavorable effects of acetate infusate or dialysate, such as cardiovascular depression, have also been reported, and although the number of studies reporting favorable effects on cardiovascular metabolism is increasing, it is still a matter of controversy. It is clear, however, that acetate can be metabolized in the liver as well as in extrahepatic organs yielding bicarbonate, which can be utilized as an alkalizing agent. Recently, the authors reported new experimental findings that sodium acetate was metabolized to ketone bodies by the kidney during hepatic inflow occlusion. Ketone bodies attract considerable attention as energy substrates in the stress phase and in the reduced redox state. Administration of sodium acetate under such conditions may therefore contribute as substrate supply.