title: The physiological effects of hyperosmolar resuscitation: 5% vs 3% hypertonic saline.
abstract: BACKGROUND
  Use of 5% normal saline (NS) is gaining renewed interest. The primary aim of our study was to compare the physiological effects after the administration of different concentrations of hypertonic saline (3% vs 5%NS) in the initial resuscitation of trauma.
  
  
  METHODS
  We performed a retrospective analysis of a prospectively collected database of all trauma patients who received hypertonic saline during initial resuscitation. Medical records were reviewed for serum electrolytes and serum osmolarity, coagulation parameters, complications, and mortality.
  
  
  RESULTS
  A total of 212 patients were included in the study, of which 170 patients received 5%NS and 42 patients received 3%NS. Both groups were similar in age (41.16 ± 19 vs 44.17 + 23.6; P = .45) and ISS score (26 [17 to 29] vs 25 [16 to 27]; P = .6). Mean serum osmolarity (316 ± 20.3 vs 294 ± 22.5; P = .02) and serum sodium levels (143 ± 8.6 vs 137 ± 10.9; P < .001) remained higher in the 5%NS group within 72 hours of admission. The pH was lower in the 5%NS group compared with the 3%NS group at 24 hours (7.29 ± .12 vs 7.33 ± .12; P = .01); however, at 48 and 72 hours (7.40 ± .07 vs 7.41 ± .07; P = .7), no difference was found. There was no difference in blood products requirement (1,734 vs 2,253 mL; P = .11) between the 2 groups.
  
  
  CONCLUSIONS
  The 5%NS has sustained higher serum osmolarity and serum sodium concentration within the first 72 hours without any increase in adverse effects in comparison with 3%NS.
authors.affiliation: Section of Trauma, Emergency Surgery, Critical Care, and Burns, Department of Surgery, College of Medicine, University of Arizona College of Medicine, 1501 North Campbell Avenue, PO Box 245063, Tucson, AZ 85724-5063, USA. Electronic address: bjoseph@surgery.arizona.edu.
authors.forename: Bellal
authors.initials: B
authors.lastname: Joseph
authors.affiliation: Section of Trauma, Emergency Surgery, Critical Care, and Burns, Department of Surgery, College of Medicine, University of Arizona College of Medicine, 1501 North Campbell Avenue, PO Box 245063, Tucson, AZ 85724-5063, USA.
authors.forename: Hassan
authors.initials: H
authors.lastname: Aziz
authors.affiliation: Section of Trauma, Emergency Surgery, Critical Care, and Burns, Department of Surgery, College of Medicine, University of Arizona College of Medicine, 1501 North Campbell Avenue, PO Box 245063, Tucson, AZ 85724-5063, USA.
authors.forename: Margeaux
authors.initials: M
authors.lastname: Snell
authors.affiliation: Section of Trauma, Emergency Surgery, Critical Care, and Burns, Department of Surgery, College of Medicine, University of Arizona College of Medicine, 1501 North Campbell Avenue, PO Box 245063, Tucson, AZ 85724-5063, USA.
authors.forename: Viraj
authors.initials: V
authors.lastname: Pandit
authors.affiliation: Section of Trauma, Emergency Surgery, Critical Care, and Burns, Department of Surgery, College of Medicine, University of Arizona College of Medicine, 1501 North Campbell Avenue, PO Box 245063, Tucson, AZ 85724-5063, USA.
authors.forename: Daniel
authors.initials: D
authors.lastname: Hays
authors.affiliation: Section of Trauma, Emergency Surgery, Critical Care, and Burns, Department of Surgery, College of Medicine, University of Arizona College of Medicine, 1501 North Campbell Avenue, PO Box 245063, Tucson, AZ 85724-5063, USA.
authors.forename: Narong
authors.initials: N
authors.lastname: Kulvatunyou
authors.affiliation: Section of Trauma, Emergency Surgery, Critical Care, and Burns, Department of Surgery, College of Medicine, University of Arizona College of Medicine, 1501 North Campbell Avenue, PO Box 245063, Tucson, AZ 85724-5063, USA.
authors.forename: Andrew
authors.initials: A
authors.lastname: Tang
authors.affiliation: Section of Trauma, Emergency Surgery, Critical Care, and Burns, Department of Surgery, College of Medicine, University of Arizona College of Medicine, 1501 North Campbell Avenue, PO Box 245063, Tucson, AZ 85724-5063, USA.
authors.forename: Terence
authors.initials: T
authors.lastname: O'Keeffe
authors.affiliation: Section of Trauma, Emergency Surgery, Critical Care, and Burns, Department of Surgery, College of Medicine, University of Arizona College of Medicine, 1501 North Campbell Avenue, PO Box 245063, Tucson, AZ 85724-5063, USA.
authors.forename: Julie
authors.initials: J
authors.lastname: Wynne
authors.affiliation: Section of Trauma, Emergency Surgery, Critical Care, and Burns, Department of Surgery, College of Medicine, University of Arizona College of Medicine, 1501 North Campbell Avenue, PO Box 245063, Tucson, AZ 85724-5063, USA.
authors.forename: Randall S
authors.initials: RS
authors.lastname: Friese
authors.affiliation: Section of Trauma, Emergency Surgery, Critical Care, and Burns, Department of Surgery, College of Medicine, University of Arizona College of Medicine, 1501 North Campbell Avenue, PO Box 245063, Tucson, AZ 85724-5063, USA.
authors.forename: Peter
authors.initials: P
authors.lastname: Rhee
mesh_terms: D000328:Adult; D000368:Aged; D015415:Biomarkers / Q000097:blood; D005260:Female; D005440:Fluid Therapy / Q000379:methods*; D006801:Humans; D006863:Hydrogen-Ion Concentration / Q000187:drug effects; D008297:Male; D008875:Middle Aged; D009994:Osmolar Concentration; D012151:Resuscitation / Q000379:methods*; D012189:Retrospective Studies; D012462:Saline Solution, Hypertonic / Q000494:pharmacology* / Q000627:therapeutic use; D012964:Sodium / Q000097:blood; D016896:Treatment Outcome; D014947:Wounds and Injuries / Q000097:blood / Q000503:physiopathology / Q000628:therapy*
chemical_list: D015415:Biomarkers; D012462:Saline Solution, Hypertonic; D012964:Sodium
keywords: 5% Normal saline; Complications; Hypertonic saline; Physiological effects; Serum sodium