Hyperosmotic sodium salts reverse severe hemorrhagic shock: other solutes do not.
Severe hemorrhage in pentobarbital-anesthetized dogs (25 mg/kg) is reversed by intravenous NaCl (4 ml/kg, 2,400 mosmol/l, 98% long-term survival). This paper compares survival rates and hemodynamic and metabolic effects of hypertonic NaCl with sodium salts (acetate, bicarbonate, and nitrate), chlorides [lithium and tris(hydroxymethyl)aminomethane (Tris)], and nonelectrolytes (glucose, mannitol, and urea) after severe hemorrhage (44.5 +/- 2.3 ml/kg blood loss). Sodium salts had higher survival rates (chloride, 100%; acetate, 72%; bicarbonate, 61%; nitrate, 55%) with normal stable arterial pressure after chloride and nitrate; near normal cardiac output after sodium chloride; normal acid-base equilibrium after all sodium salts; and normal mean circulatory filling pressure after chloride, acetate, and bicarbonate. Chlorides and nonelectrolytes produced low survival rates (glucose and lithium, 5%; mannitol, 11%; Tris, 22%; urea, 33%) with low cardiac output, low mean circulatory filling pressure, and severe metabolic acidosis. Plasma sodium, plasma bicarbonate, mean circulatory filling pressure, cardiac output, and arterial pressure correlated significantly with survival; other parameters, including plasma volume expansion or plasma osmolarity, did not. It is proposed that high plasma sodium is essential for survival.
Rocha e Silva
M
M
Research Division, Heart Institute, Faculdade de Medicina, Universidade de São Paulo, Brazil.
Velasco
I T
IT
Nogueira da Silva
R I
RI
Oliveira
M A
MA
Negraes
G A
GA
Oliveira
M A
MA
D000085:Acetates / Q000627:therapeutic use; D019342:Acetic Acid; D000818:Animals; D001639:Bicarbonates / Q000627:therapeutic use; D001784:Blood Gas Analysis; D001794:Blood Pressure / Q000187:drug effects; D002302:Cardiac Output / Q000187:drug effects; D002712:Chlorides / Q000627:therapeutic use; D004285:Dogs; D004573:Electrolytes / Q000097:blood; D005947:Glucose / Q000627:therapeutic use; D006439:Hemodynamics / Q000187:drug effects; D008094:Lithium / Q000627:therapeutic use; D008297:Male; D008353:Mannitol / Q000627:therapeutic use; D009566:Nitrates / Q000627:therapeutic use; D012462:Saline Solution, Hypertonic / Q000627:therapeutic use*; D012771:Shock, Hemorrhagic / Q000628:therapy*; D012964:Sodium / Q000627:therapeutic use; D017693:Sodium Bicarbonate; D012965:Sodium Chloride / Q000627:therapeutic use*; D012996:Solutions; D014325:Tromethamine / Q000627:therapeutic use; D014508:Urea / Q000627:therapeutic use
D000085:Acetates; D001639:Bicarbonates; D002712:Chlorides; D004573:Electrolytes; D009566:Nitrates; D012462:Saline Solution, Hypertonic; D012996:Solutions; D014325:Tromethamine; D008353:Mannitol; D012965:Sodium Chloride; C031618:sodium nitrate; D017693:Sodium Bicarbonate; D014508:Urea; D008094:Lithium; D012964:Sodium; D005947:Glucose; D019342:Acetic Acid