Rubbing salt into wounds: hypertonic saline to assist with volume removal in heart failure.
Traditionally accepted management strategies for patients with heart failure include sodium and fluid restriction, neurohormonal blockade, and the use of loop diuretics to achieve and maintain euvolemia. Despite continued advances in medical and device therapy, fluid management remains a significant problem in patients with the cardiorenal syndrome (manifested as diuretic resistance and worsening renal function with more aggressive attempts at volume removal). This article examines the counterintuitive use of hypertonic saline as a potential therapy to facilitate diuresis in patients with decompensated heart failure and diuretic resistance. Low-volume hypertonic saline administration offsets counterproductive neurohormonal upregulation, transiently improves hemodynamics, and promotes renal sodium excretion with accompanied net water loss and preservation of renal function. This "new" therapeutic tool should be explored further as an adjunct to current medical therapies in the management of patients with refractory volume overload.
Liszkowski
Mark
M
Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115, USA.
Nohria
Anju
A
D006348:Cardiac Surgical Procedures; D004351:Drug Resistance; D006333:Heart Failure / Q000150:complications / Q000188:drug therapy* / Q000503:physiopathology; D006439:Hemodynamics; D006801:Humans; D007677:Kidney Function Tests; D051437:Renal Insufficiency / Q000150:complications / Q000188:drug therapy / Q000503:physiopathology; D012151:Resuscitation / Q000379:methods*; D012462:Saline Solution, Hypertonic / Q000627:therapeutic use*; D012769:Shock / Q000188:drug therapy; D049994:Sodium Potassium Chloride Symporter Inhibitors / Q000627:therapeutic use
D012462:Saline Solution, Hypertonic; D049994:Sodium Potassium Chloride Symporter Inhibitors