title: Hypertonic sodium lactate improves fluid balance and hemodynamics in porcine endotoxic shock.
abstract: BACKGROUND
  Based on the potential interest in sodium lactate as an energy substrate and resuscitative fluid, we investigated the effects of hypertonic sodium lactate in a porcine endotoxic shock.
  
  
  METHODS
  Fifteen anesthetized, mechanically ventilated pigs were challenged with intravenous infusion of E. coli endotoxin. Three groups of five animals were randomly assigned to receive 5 mL/kg/h of different fluids: a treatment group received hypertonic sodium lactate 11.2% (HSL group); an isotonic control group receiving 0.9% NaCl (NC group); a hypertonic control group with the same amount of osmoles and sodium than HSL group receiving hypertonic sodium bicarbonate 8.4% (HSB group). Hemodynamic and oxygenation variables, urine output and fluid balance were measured at baseline and at 30, 60, 120, 210 and 300 min. Skin microvascular blood flow at rest and during reactive hyperemia was obtained using a laser Doppler flowmetry technique. Results were given as median with interquartile ranges.
  
  
  RESULTS
  Endotoxin infusion resulted in hypodynamic shock. At 300 min, hemodynamics and oxygenation were significantly enhanced in HSL group: mean arterial pressure (103 [81-120] mmHg vs. 49 [41-62] in NC group vs. 71 [60-78] in HSB group), cardiac index (1.6 [1.2-1.8] L/min/m2 vs. 0.9 [0.5-1.1] in NC group vs. 1.3 [0.9-1.6] in HSB group) and partial pressure of oxygen (366 [308-392] mmHg vs. 166 [130-206] in NC group vs. 277 [189-303] in HSB group). At the same time, microvascular reactivity was significantly better in HSL group with a lower venoarterial CO2 tension difference (5.5 [4-10] mmHg vs. 17 [14-25] in NC group vs. 14 [12-15] in HSB group). The cumulative fluid balance was lower in HSL group (-325 [-655; -150] mL) compared to NC (+560 [+230; +900] mL, p = 0.008) and HSB (+185 [-110; +645] mL, p = 0.03) groups.
  
  
  CONCLUSIONS
  In our hypodynamic model of endotoxic shock, infusion of hypertonic sodium lactate improves hemodynamic and microvascular reactivity with a negative fluid balance and a better oxygenation.
authors.forename: Thibault
authors.initials: T
authors.lastname: Duburcq
authors.forename: Raphaël
authors.initials: R
authors.lastname: Favory
authors.forename: Daniel
authors.initials: D
authors.lastname: Mathieu
authors.forename: Thomas
authors.initials: T
authors.lastname: Hubert
authors.forename: Jacques
authors.initials: J
authors.lastname: Mangalaboyi
authors.forename: Valery
authors.initials: V
authors.lastname: Gmyr
authors.forename: Laurence
authors.initials: L
authors.lastname: Quintane
authors.forename: Patrice
authors.initials: P
authors.lastname: Maboudou
authors.forename: François
authors.initials: F
authors.lastname: Pattou
authors.forename: Mercé
authors.initials: M
authors.lastname: Jourdain
mesh_terms: D000818:Animals; D001786:Blood Glucose / Q000378:metabolism; D004195:Disease Models, Animal; D005260:Female; D005440:Fluid Therapy; D006439:Hemodynamics / Q000187:drug effects*; D006863:Hydrogen-Ion Concentration; D006982:Hypertonic Solutions / Q000627:therapeutic use; D007262:Infusions, Intravenous; D007668:Kidney / Q000503:physiopathology; D019344:Lactic Acid / Q000097:blood; D008833:Microcirculation / Q000187:drug effects*; D011446:Prospective Studies; D011897:Random Allocation; D012772:Shock, Septic / Q000188:drug therapy* / Q000503:physiopathology; D019354:Sodium Lactate / Q000627:therapeutic use*; D013552:Swine; D014556:Urine; D014882:Water-Electrolyte Balance / Q000187:drug effects*
chemical_list: D001786:Blood Glucose; D006982:Hypertonic Solutions; D019344:Lactic Acid; D019354:Sodium Lactate