title: Clinical experience using 5% hypertonic saline as a safe alternative fluid for use in trauma.
abstract: BACKGROUND
  Published experience of hypertonic saline (HTS) use in resuscitation has described the use of commercially unavailable 7.5% solutions. The purpose of this study was to compare our experience with the administration of commercially available 5% HTS solution with that of well-matched controls who did not receive HTS.
  
  
  METHODS
  Prospective observational study of 51 trauma patients receiving 500 mL of 5% HTS during initial resuscitation. Patients who received HTS were 1:2 matched using age, gender, Injury Severity Score, Coma Score, Head Abbreviated Injury Scale, and injury mechanism to trauma patients who did not receive HTS. The laboratory values and outcomes of the two groups were compared.
  
  
  RESULTS
  Patients receiving HTS demonstrated no difference from the matched cohort in mean pH, international normalized ratio, or p/f ratios at 8 hours or 24 hours. The mean serum sodium of the HTS group was higher than controls at 8 hours (143.1 vs. 150.1 mg/dL, p < 0.001) and remained significantly more increased for 3 days without any adverse sequelae related to hypernatremia. No difference in mortality was noted between the two groups. A trend in decreased mortality was observed in patients with Coma Score <or=8 and Head Abbreviated Injury Scale score >or=3 (25.0% vs. 42.5%). The mean ventilator days were 7.3 for HTS group and 9.2 for the non-HTS group.
  
  
  CONCLUSIONS
  Although serum sodium remained increased for several days after HTS administration, no adverse sequelae as a result of hypernatremia resulted. Commercially available 5% HTS solution is safe for use in the resuscitation of trauma patients and may improve outcomes in a selected subset of patients with head injury.
authors.affiliation: Division of Trauma, University of Southern California Medical Center, Los Angeles County, Los Angeles, California, USA.
authors.forename: Joseph J
authors.initials: JJ
authors.lastname: DuBose
authors.forename: Leslie
authors.initials: L
authors.lastname: Kobayashi
authors.forename: Alfredo
authors.initials: A
authors.lastname: Lozornio
authors.forename: Pedro
authors.initials: P
authors.lastname: Teixeira
authors.forename: Kenji
authors.initials: K
authors.lastname: Inaba
authors.forename: Lydia
authors.initials: L
authors.lastname: Lam
authors.forename: Peep
authors.initials: P
authors.lastname: Talving
authors.forename: Bernardino
authors.initials: B
authors.lastname: Branco
authors.forename: Demetrios
authors.initials: D
authors.lastname: Demetriades
authors.forename: Peter
authors.initials: P
authors.lastname: Rhee
mesh_terms: D015998:Abbreviated Injury Scale; D000293:Adolescent; D000328:Adult; D000368:Aged; D000704:Analysis of Variance; D016009:Chi-Square Distribution; D005260:Female; D005440:Fluid Therapy / Q000009:adverse effects / Q000379:methods*; D006801:Humans; D006955:Hypernatremia / Q000097:blood / Q000139:chemically induced; D015601:Injury Severity Score; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012121:Respiration, Artificial / Q000706:statistics & numerical data; D012151:Resuscitation / Q000009:adverse effects / Q000379:methods*; D012449:Safety; D012462:Saline Solution, Hypertonic / Q000009:adverse effects / Q000627:therapeutic use*; D012964:Sodium / Q000097:blood; D014194:Traumatology / Q000379:methods*; D016896:Treatment Outcome; D014947:Wounds and Injuries / Q000175:diagnosis / Q000209:etiology / Q000401:mortality / Q000628:therapy*
chemical_list: D012462:Saline Solution, Hypertonic; D012964:Sodium