(Ab)normal saline and physiological Hartmann's solution: a randomized double-blind crossover study.
In this double-blind crossover study, the effects of bolus infusions of 0.9% saline (NaCl) and Hartmann's solution on serum albumin, haematocrit and serum and urinary biochemistry were compared in healthy subjects. Nine young adult male volunteers received 2-litre intravenous infusions of 0.9% saline and Hartmann's solution on separate occasions, in random order, each over 1 h. Body weight, haematocrit and serum biochemistry were measured pre-infusion and at 1 h intervals for 6 h. Biochemical analysis was performed on pooled post-infusion urine. Blood and plasma volume expansion, estimated by dilutional effects on haematocrit and serum albumin, were greater and more sustained after saline than after Hartmann's solution (P <0.01). At 6 h, body weight measurements suggested that 56% of the infused saline was retained, in contrast with only 30% of the Hartmann's solution. Subjects voided more urine (median: 1,000 compared with 450 ml) of higher sodium content (median: 122 compared with 73 mmol) after Hartmann's than after saline (both P =0.049), despite the greater sodium content of the latter. The time to first micturition was less after Hartmann's than after saline (median: 70 compared with 185 min; P =0.008). There were no significant differences between the effects of the two solutions on serum sodium, potassium, urea or osmolality. After saline, all subjects developed hyperchloraemia (>105 mmol/l), which was sustained for >6 h, while serum chloride concentrations remained normal after Hartmann's (P <0.001 for difference between infusions). Serum bicarbonate concentration was significantly lower after saline than after Hartmann's (P =0.008). Thus excretion of both water and sodium is slower after a 2-litre intravenous bolus of 0.9% saline than after Hartmann's solution, due possibly to the more physiological [Na(+)]/[Cl(-)] ratio in Hartmann's solution (1.18:1) than in saline (1:1) and to the hyperchloraemia caused by saline.
Reid
Fiona
F
Section of Surgery, University Hospital, Queen's Medical Centre, Nottingham NG7 2UH, UK.
Lobo
Dileep N
DN
Williams
Robert N
RN
Rowlands
Brian J
BJ
Allison
Simon P
SP
D000328:Adult; D001835:Body Weight / Q000187:drug effects; D018592:Cross-Over Studies; D004311:Double-Blind Method; D005440:Fluid Therapy / Q000379:methods*; D006400:Hematocrit; D006801:Humans; D007552:Isotonic Solutions / Q000493:pharmacokinetics / Q000494:pharmacology*; D008297:Male; D009318:Natriuresis / Q000187:drug effects; D009994:Osmolar Concentration; D011188:Potassium / Q000097:blood; D000077325:Ringer's Lactate; D012709:Serum Albumin / Q000378:metabolism; D012964:Sodium / Q000097:blood; D012965:Sodium Chloride / Q000493:pharmacokinetics / Q000494:pharmacology*; D014508:Urea / Q000097:blood; D014554:Urination / Q000187:drug effects
D007552:Isotonic Solutions; D000077325:Ringer's Lactate; D012709:Serum Albumin; D012965:Sodium Chloride; D014508:Urea; D012964:Sodium; D011188:Potassium