Hypertonic saline treatment of uncontrolled hemorrhagic shock at different periods from bleeding
M. M. Krausz, E. H. Landau, B. Klin and D. Gross
Department of Surgery B, Hadassah University Hospital, Jerusalem, Israel.
Hypertonic saline has been recently recommended for treatment of patients
in hemorrhagic shock. Infusion of hypertonic saline at different periods in
cases of uncontrolled hemorrhagic shock was studied in rats. The animals
were divided into six groups: in group 1 uncontrolled hemorrhagic shock was
induced by tail resection and no hypertonic saline was administered; in
group 2 hypertonic saline was administered 5 minutes after shock was
induced; in group 3 hypertonic saline was administered 15 minutes after
shock was induced; in group 4 hypertonic saline was administered 30 minutes
after shock was induced; in group 5 hypertonic saline was administered 60
minutes after shock was induced; and in group 6 hypertonic saline was
administered 120 minutes after shock was induced. Tail resection in rats in
group 1 was followed by a mean +/- SEM bleeding of 2.7 +/- .03 mL in 5
minutes. Infusion of hypertonic saline after 5 and 15 minutes resulted in
additional bleeding of 6.3 +/- 1.0 mL and 3.8 +/- 0.5 mL, respectively, and
a drop in mean arterial pressure to 36 +/- 8 mm Hg and 56 +/- 9 mm Hg,
respectively. Mortality was 80% in group 2 and 53% in group 3. Infusion of
hypertonic saline 30 and 60 minutes after shock was induced did not alter
bleeding, mean arterial pressure, or survival. Infusion of hypertonic
saline within 15 minutes of hemorrhagic shock resulted in increased
bleeding, hypotension, and early death. Infusion 30 minutes or later did
not alter these variables. This potential danger of early hypertonic saline
therapy should be considered in the treatment of patients in trauma.
