0.5M Na Lactate Solution in Acute Heart Failure (AHF)
0.5M Na Lactate Solution in Acute Heart Failure (AHF)
The objective of this trial to see whether:

 -Cardiac performance (cardiac index and secondary outcomes)can be improved in patients with
 acute heart failure (AHF) and symptoms and consequences of fluid overload (pulmonary and
 interstitial edema) and poor peripheral perfusion can be reduced by:

 1. Providing lactate as a substrate(Improve cardiac index)

 2. Simultaneously restoring optimal preload

 Optimal standard treatment will be achieved in both arms with the use of current best
 treatment protocol for AHF as per independent treating physician.

 4. To assess effects of 0.5M Na lactate (Totilac) on plasma and urine biological parameters
 (sodium, potassium, chloride, pH, bicarb, base excess, albumin)

 5. To assess effects of 0.5M Na lactate on morbidity and mortality.
-  Acute heart failure is a critical illness for which current treatments are suboptimal.

 -  The various symptoms are related to inadequate cardiac output and usually include left
 ventricular overload with pulmonary oedema, interstitial fluid accumulation and tissue
 oedema (as indicated by frequent hyponatremia and hypoalbuminemia) and insufficient
 peripheral perfusion frequently manifesting as cold extremities and low urine output.

 -  The current treatment of this syndrome is based on diuretics, vasodilators and/or
 inotropes, but fluid administration is also required to optimise the intravascular
 volume state and to reverse shock if present. Therefore management of body fluid balance
 remains a challenge since treatment aims to simultaneously maintain or improve
 intravascular volume and decrease body fluid excess and oedema.

 -  The purpose of the present study is to assess in a prospective randomised trial the
 efficacy and safety of a newly designed crystalloid solution, 0.5 M sodium lactate, with
 properties potentially able to improve multiple pathophysiological aspects of AHF, as
 compared to the use of standard crystalloid solution Compound Sodium Lactate (mildly
 hypoosmolar ~ 274 mOsm/L and isotonic).
Inclusion Criteria:

 -  Age: more than 18 years

 -  Heart failure criteria:

 Left heart failure: as evidenced by 2 out of 3:

 -  Left ventricular ejection fraction (LVEF) ≤ 40% and cardiac index ≤ 2.5 L/min/m2

 -  Acute pulmonary oedema of cardiac origin or mechanical ventilation (including
 CPAP/BIPAP) for respiratory failure of predominantly cardiac origin

 -  Need for inotropes/vasopressors for cardiac pump failure OR

 Right heart failure: as evidenced by 1 out of 2:

 -  Bilateral leg oedema above ankles

 -  RV failure (low tricuspid annular plane systolic excursion (TAPSE), dilated floppy RV)

 -  Poor peripheral perfusion as evidenced by 2 out of 3:

 Cold mottled skin Low urine output Acutely clouded sensorium/poor mentation

 -  Consent obtained from patient or patient's next of kin.

 Exclusion Criteria:

 -  Hypernatremia: [Na] >145 mmol/L

 -  Diagnosed hypertrophic obstructive cardiomyopathy

 -  Uncorrected severe valvular heart disease

 -  Documented third degree heart block, sustained ventricular tachycardia

 -  Documented cardiac tamponade

 -  Septic shock

 -  Acute respiratory distress syndrome (ARDS)

 -  Moribund patients likely to die before 24h

 -  Patients with major diseases of limited prognosis such as end stage cancer,end-stage
 liver failure, end stage dialysis dependent renal failure

 -  Patients with absolute indication for acute hemodialysis/hemofiltration (pH, K, urea >
 35 mmol/L, severe fluid overload in the presence of oliguria < 200 mL/6h.

 -  Known pregnancy