Hypertonic saline and hemorrhagic shock: hepatocellular function and integrity after six hours of treatment

Abstract

Purpose:The comparison after 6h of hemorrhagic shock (HS) treatment with NaCl 7.5% (Hypertonic Saline Solution -SSH) or Ringer Lactate (RL) on liver function and integrity. Methods: Male Wistar rats were submitted to HS (Mean Arterial Pressure -MAP= 45 mmHg) during 60 min and then treated with NaCl 7.5% (SSH, 10% of blood loss, n=8) or Ringer Lactate (RL, 400% of blood loss, n=8). After 6h rats were anesthetized, hepatic function was assessed by bile flow measurement and liver integrity evaluated by determination of alanine aminotransferase (ALT) and bilirubin activities. Results: There was no difference in MAP between the groups during the whole experiments. Biliary flow showed a significant recovery after SSH treatment (p<0.05), and significant decrease of ALT (p<0.001) and bilirubin levels (p<0.001) in comparison to RL. Conclusion: Resuscitation of HS with NaCl 7.5% promoted better recovery of liver function and lesser hepatocellular damage after 6h of treatment compared to RL. The improvement is very likely related to increased microvascular perfusion provided by small volume resuscitation. Key words: Ischemia. Reperfusion. Shock, Hemorrhagic. Saline Solution, Hypertonic. Liver. Rats. RESUMO Objetivo:Comparar os efeitos após 6 horas do tratamento do choque hemorrágico (CH) com solução de NaCl 7,5% (Solução Salina Hipertônica -SSH) e Ringer Lactato (RL) sobre a função e integridade hepática em ratos. Métodos: Ratos Wistar (n=16) machos foram submetidos a choque hemorrágico controlado (Pressão Arterial Média -PAM = 45 mmHg) durante 60 minutos e após ressuscitados com SSH (10% da perda volêmica, n=8) ou RL (4 vezes o volume sangüíneo retirado, n=8). Após 6 horas a função hepática foi determinada pela quantificação do fluxo biliar. A integridade hepática foi avaliada pelas bilirrubinas e pela alanino aminotransferase (ALT). Resultados: Não foi constatada diferença de PAM entre os grupos durante os experimentos. O fluxo biliar apresentou recuperação significativa no grupo SSH em comparação ao grupo RL (p<0,05). O grupo SSH apresentou diminuição significativa nos níveis de ALT (p<0,001) e das bilirrubinas (p<0,001). Conclusão: Após 6 horas de tratamento do choque hemorrágico a SSH mostrou-se superior ao RL, recuperando a função e a integridade hepatocelular, provavelmente por melhora da perfusão nutricional hepática, e diretamente relacionada ao seu mecanismo de ação. Descritores: Isquemia. Reperfusão. Choque Hemorrágico. Solução Salina Hipertônica. Fígado Ratos.

Effects of Hyperosmotic Sodium Chloride Perfusion on Ischemia/Reperfusion Injury in Isolated Hearts of Normal and Stroke-Prone Spontaneously Hypertensive Rats

“…Previous study had shown that hypertonic saline with a colloid solution improved myocardial circulation in sepsis [25]. Hypertonic perfusion was also reported to reduce myocardial injury by reducing edema and diminishing calcium accumulation via decreasing Na/Ca exchange-mediated pathway during hypoxia [19,26]. Therefore, the enhanced myocardial anti-oxidative capacity in hyperosmolarityperfused hearts and enhanced coronary vasodilation may act in concert to reduce myocardial injury.…”

Hypertonic saline resuscitation maintains a more balanced profile of T-lymphocyte subpopulations in a rat model of hemorrhagic shock

“…It was soon realized that the physiological vasodilator property of hypertonicity was a useful byproduct of small volume resuscitation in that it induced reperfusion of previously ischemic territories. Subsequently, a number of researches disclosed previously unsuspected properties of HTS resuscitation, amongst them the correction of endothelial and red cell edema accompanying significant consequences in capillary blood flow (Victorino et al, 2003;Homma et al, 2005;Hoppen et al, 2005;Cruz et al, 2006).…”

Hypertonic saline resuscitation reduces apoptosis of intestinal mucosa in a rat model of hemorrhagic shock

“…Firstly, HTS resuscitation effectively ameliorates the cellular metabolisms by inducing a considerable microcirculatory improvement and restoring intestinal perfusion, which can reduce abnormal apoptosis of small intestinal mucosa (Murao et al, 2003;Shires et al, 2005). This positive effect of HTS is related to the correction of endothelial or red cell edema and selective vasodilation of the precapillary arteriole, accompanying significant consequences in capillary blood flow (Victorino et al, 2003;Vajda et al, 2004;Homma et al, 2005;Hoppen et al, 2005;Zakaria et al, 2006). Secondly, hemorrhagic shock causes a whole body ischemiareperfusion injury, leading to multiple organ dysfunctions.…”