Hyperkalemia accompanies hemorrhagic shock and correlates with mortality.
OBJECTIVE
This study was designed to evaluate the effects of terlipressin versus fluid resuscitation with normal saline, hypertonic saline or hypertonic-hyperoncotic hydroxyethyl starch, on hemodynamics, metabolics, blood loss and short-term survival in hemorrhagic shock.


METHODS
Twenty-nine pigs were subjected to severe liver injury and treated 30 min later with either: (1) 2 mg terlipressin in a bolus, (2) placebo-treated controls, (3) 4 mL/kg 7.5% hypertonic NaCl, (4) 4 mL/kg 7.2% hypertonic-hyperoncotic hydroxyethyl starch 200/0.5, or (5) normal saline at three times lost blood volume.


RESULTS
The overall mortality rate was 69%. Blood loss was significantly higher in the hypertonic-hyperoncotic hydroxyethyl starch and normal saline groups than in the terlipressin, hypertonic NaCl and placebo-treated controls groups (p<0.005). Hyperkalemia (K>5 mmol/L) before any treatment occurred in 66% of the patients (80% among non-survivors vs. 22% among survivors, p=0.019). Post-resuscitation hyperkalemia occurred in 86.66% of non-survivors vs. 0% of survivors (p<0.001). Hyperkalemia was the first sign of an unsuccessful outcome for the usual resuscitative procedure and was not related to arterial acidemia. Successfully resuscitated animals showed a significant decrease in serum potassium levels relative to the baseline value.


CONCLUSIONS
Hyperkalemia accompanies hemorrhagic shock and, in addition to providing an early sign of the acute ischemic insult severity, may be responsible for cardiac arrest related to hemorrhagic shock.
Rocha Filho
Joel Avancini
JA
Department of Anesthesiology, Hospital das Clinicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil. joelrocha@mac.com
Nani
Ricardo Souza
RS
D'Albuquerque
Luiz Augusto Carneiro
LA
Holms
Carla Augusto
CA
Rocha
João Plínio Souza
JP
Sá Malbouisson
Luís Marcelo
LM
Machado
Marcel Cerqueira César
MC
Carmona
Maria José Carvalho
MJ
Auler Júnior
José Otávio Costa
JO
D000818:Animals; D004195:Disease Models, Animal; D005440:Fluid Therapy / Q000379:methods; D006323:Heart Arrest / Q000628:therapy*; D006490:Hemostatics / Q000627:therapeutic use*; D006947:Hyperkalemia / Q000401:mortality / Q000628:therapy*; D008236:Lypressin / Q000031:analogs & derivatives* / Q000627:therapeutic use; D008297:Male; D012151:Resuscitation / Q000379:methods*; D012771:Shock, Hemorrhagic / Q000401:mortality / Q000628:therapy*; D015996:Survival Rate; D013552:Swine; D000077585:Terlipressin
D006490:Hemostatics; D008236:Lypressin; D000077585:Terlipressin