Local and systemic effects of hypertonic solution (NaCl 7.5%) in experimental acute pancreatitis.
OBJECTIVE
Severe acute pancreatitis (AP) is characterized by hemodynamic alterations and a systemic inflammatory response, leading to a high mortality rate. Treatment of hemorrhagic shock with hypertonic saline solutions significantly reduces mortality through an improvement in the hemodynamic conditions and possibly by an anti-inflammatory effect. Therefore, hypertonic solutions could be effective in AP.


METHODS
Wistar rats were divided in 4 groups: group C, control, without AP; group NT, AP, without treatment; group NS, treatment with normal saline solution (NaCl 0.9%) 1 hour after AP; group HTS, treatment with hypertonic saline solution (NaCl 7.5%) 1 hour after AP. AP was induced by injection of 2.5% sodium taurocholate into the pancreatic duct. Mean arterial blood pressure (MAP) and heart rate were recorded at 0 and 2, 4, 24, and 48 hours after AP. After induction of AP, animals were killed at 2, 12, 24, and 48 hours for serum amylase, interleukin (IL)-6, and IL-10 analysis, pancreatic tissue culture and histologic analysis, oxidation and phosphorylation of liver mitochondria, pulmonary myeloperoxidase activity (MPO), and mortality study.


RESULTS
In animals of groups NS and NT, a significant decrease of MAP was observed 48 hours after AP (NS: 91 +/- 3 mm Hg; NT: 89 +/- 3 mm Hg) compared with baseline (C: 105 +/- 2 mm Hg) and to HTS group (HTS: 102 +/- 2 mm Hg; P < 0.05). In animals of group NT, NS, and HTS, serum IL-6 and IL-10 levels were significantly higher at 2 hours after AP compared with the control group. However, IL-6 levels at 12 hours after AP and IL-10 levels at 2 and 12 hours after AP were significant lower in group HTS compared with NS and NT groups (P < 0.05). In group HTS, a decrease of pulmonary MPO activity and of pancreatic infection was observed 24 hours after AP compared with NT and NS groups (P < 0.05). A significant reduction on pancreatic acinar necrosis and mitochondrial dysfunction was observed after 48 hours of AP in animals of group HTS compared with groups NT and NS (P < 0.05). A significant reduction on mortality was observed in HTS (0/14) compared with NS (6/17; 35%) and NT (7/20; 35%).


CONCLUSIONS
The administration of hypertonic saline solution in experimental AP attenuated hemodynamic alterations, decreased inflammatory cytokines, diminished systemic lesions and pancreatic acinar necrosis, prevented pancreatic infection, and reduced the mortality rate.
Machado
Marcel Cerqueira Cesar
MC
Department of Surgery, University of São Paulo Medical School, São Paulo, Brazil. amcoelho@usp.br
Coelho
Ana Maria M
AM
Pontieri
Vera
V
Sampietre
Sandra N
SN
Molan
Nilza A T
NA
Soriano
Francisco
F
Matheus
André S
AS
Patzina
Rosely A
RA
Cunha
José E M
JE
Velasco
Irineu T
IT
D000208:Acute Disease; D000818:Animals; D001794:Blood Pressure; D004195:Disease Models, Animal; D006339:Heart Rate; D007249:Inflammation / Q000517:prevention & control; D010195:Pancreatitis / Q000503:physiopathology / Q000628:therapy*; D051381:Rats; D017208:Rats, Wistar; D012462:Saline Solution, Hypertonic / Q000627:therapeutic use*
D012462:Saline Solution, Hypertonic