title: The Harmful Effects of Hypertonic Sodium Lactate Administration in Hyperdynamic Septic Shock.
abstract: Hypertonic sodium lactate (HTL) expands intravascular volume and may provide an alternative substrate for cellular metabolism in sepsis. We compared the effects of HTL, hypertonic saline (HTS), 0.9% ("normal") saline (NS) and Ringer's lactate (RL) on hemodynamics, sublingual and renal microcirculation, renal, mesenteric and brain perfusion, renal and cerebral metabolism, and survival in anesthetized, mechanically ventilated, adult female sheep. Animals (7 in each group) were randomized to receive a bolus (over 15-min) of 3 mL/kg 0.5 M HTL, 3 mL/kg 3% HTS, 10.8 mL/kg NS, or 10.8 mL/kg RL at 2, 6, and 10 h after induction of fecal peritonitis, followed by 2-h infusions of 1 mL/kg/h (HTL/HTS groups) or 3.6 mL/kg/h (NS/RL groups). Animals also received RL and hydroxyethyl starch (ratio 1:1) titrated to maintain pulmonary artery occlusion pressure at baseline levels throughout the experiment. Animals were observed until their spontaneous death. Fluid balance was lower in the HTL and HTS groups than in the other groups from 4 h. Hemodynamic variables were similar among groups during the first 12 h, but thereafter the HTL group had more pronounced decreases in blood pressure and cardiac function. Sublingual and renal microcirculatory abnormalities occurred earlier in the HTL group. Kidney and brain perfusion decreased more rapidly in the HTL group. Median survival times were significantly shorter in the HTL (17 h) and NS (16 h) groups than in the HTS (22 h) or RL (20 h) groups (P = 0.0029). In conclusion, in an ovine model of septic shock, administration of HTL was associated with earlier onset impaired tissue perfusion and shorter survival time. These observations raise concerns about use of HTL in septic shock.
authors.affiliation: *Department of Intensive Care, Erasme University Hospital, Université Libre de Bruxelles, Brussels, Belgium †Department of Anesthesiology, Tianjin Institute of Anesthesiology, Tianjin Medical University General Hospital, Tianjin, China ‡Department of Intensive Care, Sun Yat-sen University Cancer Center, Guangzhou, China.
authors.forename: Fuhong
authors.initials: F
authors.lastname: Su
authors.forename: Keliang
authors.initials: K
authors.lastname: Xie
authors.forename: Xinrong
authors.initials: X
authors.lastname: He
authors.forename: Diego
authors.initials: D
authors.lastname: Orbegozo
authors.forename: Koji
authors.initials: K
authors.lastname: Hosokawa
authors.forename: Emiel Hendrik
authors.initials: EH
authors.lastname: Post
authors.forename: Katia
authors.initials: K
authors.lastname: Donadello
authors.forename: Fabio Silvio
authors.initials: FS
authors.lastname: Taccone
authors.forename: Jacques
authors.initials: J
authors.lastname: Creteur
authors.forename: Jean-Louis
authors.initials: JL
authors.lastname: Vincent
mesh_terms: D000818:Animals; D001794:Blood Pressure / Q000187:drug effects; D001921:Brain / Q000187:drug effects / Q000378:metabolism; D005260:Female; D005440:Fluid Therapy; D006439:Hemodynamics / Q000187:drug effects; D007552:Isotonic Solutions / Q000627:therapeutic use; D007668:Kidney / Q000187:drug effects / Q000378:metabolism; D008833:Microcirculation / Q000187:drug effects; D012151:Resuscitation; D000077325:Ringer's Lactate; D012756:Sheep; D012772:Shock, Septic / Q000628:therapy*; D019354:Sodium Lactate / Q000627:therapeutic use*
chemical_list: D007552:Isotonic Solutions; D000077325:Ringer's Lactate; D019354:Sodium Lactate