Hypertonic sodium resuscitation is associated with renal failure and death

Eficácia da solução de cloreto de sódio a 7,5% com e sem dextran 70 a 6% na preservação da função renal de cães hipovolêmicos submetidos à isquemia-reperfusão

“…Osmolaridade é definida como uma expressão do número de partículas osmoticamente ativas que atraem a água através de membranas semipermeáveis até estabelecer-se o equilí-brio, por litro de solvente, enquanto que osmolalidade é a medida do número de partículas osmoticamente ativas por quilograma de solvente. Estima-se a osmolalidade pela seguinte fórmula: (sódio x 2) + (glicose/18) + (uréia/2,3) 22 25 . Por isso, nos grupos 2 e 3 observou-se elevação das depurações osmolar e de sódio, que indica maior perda de substân-cias osmoticamente ativas pela urina e natriurese, provavelmente provocada pela inibição da secreção de aldosterona.…”

“…Reports on high osmolarity values are in general related to high doses or repeated injections 25 . An important increase in osmolar and sodium clearance was observed in groups 2 and 3, meaning more osmotically active substances loss through urine and natriuresis, probably caused by aldosterone secretion inhibition.…”

Hypertonic Saline and Mannitol Therapy in Critical Care Neurology

“…70 There is an association between prolonged hypernatremia (serum sodium concentration >160 mEq/L) and oliguric acute renal failure observed in burn patients receiving HS as resuscitation fluid. 71 Observations of renal failure associated with HS in neurological patients is limited; 72,73 however, close monitoring of renal function is advised. Patients that already require intermittent or continuous renal replacement pose a special challenge to the use of osmotic agents.…”

A reply

“…Physicians must prescribe intravenous fluids using their judgment and the best available evidence. The available evidence in this area, however, does give a clear message: when compared to an equivalent balanced solution, saline has been shown to be consistently inferior in in-vitro [2], animal [3], volunteer [4] and patient [5] studies. These robust trials reveal inferiority in a variety of clinically relevant and patient-centred outcomes, which would make it very difficult for saline to be passed by a regulatory body if brought to the market today.…”

“…This is of course complete conjecture and worthy of further study. Intriguingly, relative to 0.9% saline, hypertonic saline following head injury is not associated with renal failure [3], while following burns relative to lactated Ringer's it is; further clues, nothing definitive [4]. Was it the balanced anion (lactate) or the absence of hydroxyethyl starch that avoided renal failure in VISEP [5]?…”