title: [Is physiological saline really physiological? Hyponatreamia treatment--small deviations from the rules of appropriate therapy create serious complications and side effects].
abstract: Physiological saline can hardly be treated as physiological as it contains qualitatively and quantitatively different amounts of electrolytes. In particular, it contains 50% more chlorine ions than serum. Physiological saline can cause metabolic acidosis and in diabetic patients hyperchloremic acidosis. In comparison with Ringer solution and plasma-lyte, physiological saline is causing higher number of untoward effects and mortality associated with surgery. Ringer solution should be used in the situations requiring expansion of extracellular fluid. Physiological saline is a solution of choice in hypochloremic alkalosis in the case of brain injuries quite unfavourable is unnecessary rapid correction with physiological saline which can lead to serious sequelae in form of brain oedema and central extrapontine myelinolysis (osmotic demyelinisation) and permanent brain lesions. The hyponatremia's treatment depends on severity of symptoms, neurological deficit motivates immediate 4-6 mmol/l infusion, but further correction should be prolonged to 24-hrs; cautious correction corresponds to 8-mmol/l for 24 hrs. The modern treatment encompasses the introduction of vasopressin receptors antagonist--vaptans.
authors.affiliation: Professor emeritus Department of Medical Rehabilitation Shalgren's Hospital Goethenburg University, Sweden.
authors.forename: Marcin
authors.initials: M
authors.lastname: Krotkiewski
mesh_terms: D001929:Brain Edema / Q000139:chemically induced; D006801:Humans; D006982:Hypertonic Solutions / Q000009:adverse effects / Q000032:analysis / Q000627:therapeutic use; D007010:Hyponatremia / Q000188:drug therapy*; D007552:Isotonic Solutions / Q000009:adverse effects* / Q000032:analysis / Q000627:therapeutic use*; D017590:Myelinolysis, Central Pontine / Q000139:chemically induced; D000077331:Ringer's Solution; D012965:Sodium Chloride / Q000009:adverse effects* / Q000032:analysis / Q000627:therapeutic use*
chemical_list: D006982:Hypertonic Solutions; D007552:Isotonic Solutions; D012965:Sodium Chloride; D000077331:Ringer's Solution
keywords: 0,9% sodium chloride solution; Ringer solution; hiperchloremic acidosis; hyponatremia; hyponatremic encephalopathy; neurologic sequelae of hyponatreamia treatment; osmolality; plasma-lyte; vaptans