(Ab)normal saline and physiological Hartmann’s solution: a randomized double-blind crossover study

Abstract

In this double-blind crossover study, the effects of bolus infusions of 0.9% saline (NaCl) and Hartmann's solution on serum albumin, haematocrit and serum and urinary biochemistry were compared in healthy subjects. Nine young adult male volunteers received 2-litre intravenous infusions of 0.9% saline and Hartmann's solution on separate occasions, in random order, each over 1 h. Body weight, haematocrit and serum biochemistry were measured pre-infusion and at 1 h intervals for 6 h. Biochemical analysis was performed on pooled post-infusion urine. Blood and plasma volume expansion, estimated by dilutional effects on haematocrit and serum albumin, were greater and more sustained after saline than after Hartmann's solution (P <0.01). At 6 h, body weight measurements suggested that 56% of the infused saline was retained, in contrast with only 30% of the Hartmann's solution. Subjects voided more urine (median: 1,000 compared with 450 ml) of higher sodium content (median: 122 compared with 73 mmol) after Hartmann's than after saline (both P =0.049), despite the greater sodium content of the latter. The time to first micturition was less after Hartmann's than after saline (median: 70 compared with 185 min; P =0.008). There were no significant differences between the effects of the two solutions on serum sodium, potassium, urea or osmolality. After saline, all subjects developed hyperchloraemia (>105 mmol/l), which was sustained for >6 h, while serum chloride concentrations remained normal after Hartmann's (P <0.001 for difference between infusions). Serum bicarbonate concentration was significantly lower after saline than after Hartmann's (P =0.008). Thus excretion of both water and sodium is slower after a 2-litre intravenous bolus of 0.9% saline than after Hartmann's solution, due possibly to the more physiological [Na(+)]/[Cl(-)] ratio in Hartmann's solution (1.18:1) than in saline (1:1) and to the hyperchloraemia caused by saline.

Resveratrol Does Not Protect from Ischemia-Induced Acute Kidney Injury in an in Vivo Rat Model

“…Negative effects of NaCl 0.9% are ascribed to its unphysiologically high chloride content. The high chloride content is associated with an increased risk of hyperchloraemic metabolic acidosis [40-43] and animal studies have suggested that it is the critical determinant for changes in renal blood flow, mediated primarily by effects on afferent and intrarenal arterial vessels [44-47]. Chloride levels of all I/R groups were significantly elevated, but of questionable physiological implication.…”

Intravenous Fluids and Acute Kidney Injury

“…Although 0.9% saline and balanced fluids can both lead to renal volume expansion, interstitial fluid retention and adverse intra-renal microvascular effects are more pronounced with 0.9% saline infusion [52,53]. Chowdhury et al [52] clearly show that 0.9% saline infusion (2 liters), when compared to the same amount of balanced fluid infusion, causes more significant reduction in the renal cortical blood flow and oxygen delivery.…”

“…High chloride-containing saline, that is, 0.9% saline contains super physiological content of chloride which, when infused in large quantities (>2 liters), can cause hyperchloremic acidosis, which may engender complications including coagulopathy, hyperkalemia and more pronounced interstitial fluid retention; 0.9% saline infusion also causes greater fluid retention (∼60% by 6 h post infusion) than that of 5% dextrose in normal adults [51]. Moreover, Chowdhury et al [52] have shown that 56% of infused saline was retained in the body 6 h after the infusion in healthy volunteers, compared to 30% retention of Hartmann's solution [53]. When 0.9% saline was compared to plasmalyte, calculated interstitial volume increased more with saline than with plasmalyte.…”

Volumentherapie bei Hämorrhagie

“…Da die Zufuhr von Laktat bei Patienten, die oh nehin Laktat im Überschuss produzieren, auch nicht sinnvoll ist, enthalten kris talloide Lösungen heute regelhaft Ace tat, Malat oder Zitrat, woraus Bikarbonat durch Metabolisierung bereitgestellt wird. Heutzutage sollen kristalloide Infusions lösungen balanciert sein [104], d. h., sie sollen das physiologische Elektrolytmus ter des Plasmas zeigen und sie sollen iso ton sein. Außerdem soll der potenzielle BE ±10 mmol/l betragen, damit sie nicht selbst zu einer Acidose beitragen, wie z.…”