Analysis of potential risks associated with 7.5% sodium chloride resuscitation of traumatic shock.
We evaluated the potential side effects of rapidly infusing 250 mL of either 7.5% sodium chloride or 7.5% sodium chloride per 6% dextran 70, using lactated Ringer's as the control, to 106 critically injured patients in two prospective double-blinded emergency department trials. Eight patients had a significant hyperchloremic acidemia in association with infusion of the hypertonic solutions, but all eight were moribund before infusion and many factors other than hyperchloremia could have contributed to their acidemia. Other blood chemistry changes that might have been associated with the hypertonic solutions, such as hyperosmolality or hypernatremia, were made insignificant by other factors, such as high blood alcohol levels or concomitant administration of sodium bicarbonate. There were no cases of central pontine myelinolysis; bleeding was not potentiated. There was no difficulty with crossmatching of blood. No anaphylactoid reactions occurred. In a setting of limited volume resuscitation, the solutions are likely to have a favorable risk-to-benefit ratio.
Department of Surgery, University of California, Davis Medical Center, Sacramento 95817.
M J
MJ
Vassar
C A
CA
Perry
J W
JW
Holcroft
D000328:Adult; D001794:Blood Pressure / Q000187:drug effects; D002712:Chlorides / Q000097:blood; D003911:Dextrans / Q000008:administration & dosage / Q000627:therapeutic use; D004311:Double-Blind Method; D006801:Humans; D007552:Isotonic Solutions / Q000627:therapeutic use; D009994:Osmolar Concentration; D010952:Plasma Substitutes / Q000627:therapeutic use; D012044:Regression Analysis; D012151:Resuscitation; D000077325:Ringer's Lactate; D012307:Risk Factors; D012462:Saline Solution, Hypertonic / Q000008:administration & dosage / Q000627:therapeutic use*; D012774:Shock, Traumatic / Q000097:blood / Q000188:drug therapy* / Q000628:therapy; D012964:Sodium / Q000097:blood
D002712:Chlorides; D003911:Dextrans; D007552:Isotonic Solutions; D010952:Plasma Substitutes; D000077325:Ringer's Lactate; D012462:Saline Solution, Hypertonic; D012964:Sodium