Hypertonic saline attenuates the hormonal response to injury

We reported previously in a randomized double-blinded study in 20 postoperative coronary bypass patients that hypertonic saline (1.8% NaCl, HS) provides early hemodynamic benefits, increased osmolality and net negative fluid balance compared to 0.9% NaCl (NS). To investigate the effects of HS on the...

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Bibliographic Details
Published in:Annals of surgery 1989-06, Vol.209 (6), p.684-692
Main Authors: CROSS, J. S, GRUBER, D. P, GANN, D. S, SINGH, A. K, MORAN, J. M, BURCHARD, K. W
Format: Article
Language:English
Subjects:
Adrenocorticotropic Hormone - blood
Aldosterone - blood
Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy
Angiotensin II - blood
Atrial Natriuretic Factor - blood
Biological and medical sciences
Emergency and intensive care: injuries, diseases due to physical agents. Diving. Drowning. Disaster medicine
Hormones - blood
Humans
Hydrocortisone - blood
Intensive care medicine
Isotonic Solutions
Medical sciences
Myocardial Revascularization
Postoperative Period
Random Allocation
Saline Solution, Hypertonic
Sodium Chloride
Vasopressins - blood
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Summary:We reported previously in a randomized double-blinded study in 20 postoperative coronary bypass patients that hypertonic saline (1.8% NaCl, HS) provides early hemodynamic benefits, increased osmolality and net negative fluid balance compared to 0.9% NaCl (NS). To investigate the effects of HS on the hormonal response to injury, we measured ACTH, cortisol, angiotensin II (AII), aldosterone, vasopressin (AVP), and atrial natriuretic factor (ANF) in these patients. ACTH and cortisol concentrations increased in the NS group but were suppressed in the HS group (p less than 0.05). Aldosterone increased in NS patients, but was suppressed in HS patients (HS: delta Aldosterone 13.0 +/- 3.0 vs. NS: delta Aldosterone 26.0 +/- 7.0 ng/dl, p less than 0.05). The AII response was suppressed at six and eight hours (p less than 0.05) in patients receiving HS but did not change in patients receiving NS. ANF did not change significantly for either group. The significant increases in AVP were similar in both groups (p less than 0.05), but correlated with increases in osmolality only in the NS group (r = 0.8, p less than 0.009). Other than AVP, HS suppressed the responses of some of the hormones that normally increase in response to injury, relative to NS. Attenuation of the neuroendocrine response and other previously reported effects of HS suggest that HS may be an efficacious solution for resuscitation in the postoperative and postinjury period.
ISSN:0003-4932
1528-1140
DOI:10.1097/00000658-198906000-00005