title: Renal, cerebral, and pulmonary effects of hypertonic resuscitation in a porcine model of hemorrhagic shock.
abstract: To determine the safety and efficacy of a hypertonic solution for hypovolemic resuscitation, we compared the acute and delayed effects of hypertonic sodium lactate solution (514 mOsm) to Ringer's lactate solution (274 mOsm) in a porcine model of hemorrhagic shock. Cardiovascular, pulmonary, renal, and cerebral functions were examined in mature swine after their blood volume had been reduced by 40%. Hemorrhage produced significant decreases in blood pressure, cardiac output, and creatinine clearance, which were reversed with resuscitation. Resuscitation with Ringer's lactate solution required significantly more fluid and produced a significantly greater increase in intracranial pressure than did hypertonic sodium lactate solution. HSL produced significant increases in serum sodium and osmolality, which resolved within 48 hours. Hypernatremia and hyperosmolality were not associated with renal or cerebral dysfunction and were corrected through increased sodium excretion, free water intake, and a negative free water clearance.
authors.affiliation: Department of Surgery, UCSD Medical Center 92103.
authors.forename: S R
authors.initials: SR
authors.lastname: Shackford
authors.forename: C H
authors.initials: CH
authors.lastname: Norton
authors.forename: M M
authors.initials: MM
authors.lastname: Todd
mesh_terms: D000818:Animals; D001794:Blood Pressure; D001921:Brain / Q000503:physiopathology*; D002302:Cardiac Output; D003404:Creatinine / Q000378:metabolism; D004195:Disease Models, Animal; D005260:Female; D006439:Hemodynamics; D006982:Hypertonic Solutions; D007427:Intracranial Pressure; D007668:Kidney / Q000503:physiopathology*; D007773:Lactates; D019344:Lactic Acid; D008168:Lung / Q000503:physiopathology*; D008297:Male; D009994:Osmolar Concentration; D012771:Shock, Hemorrhagic / Q000503:physiopathology / Q000628:therapy*; D012964:Sodium / Q000378:metabolism; D013552:Swine
chemical_list: D006982:Hypertonic Solutions; D007773:Lactates; D019344:Lactic Acid; D012964:Sodium; D003404:Creatinine