Acid base and electrolyte changes after hypertonic saline (7.5%) infusion: A randomized controlled clinical trial

Abstract

Hypertonic saline solutions are effective in the treatment of haemorrhagic and septic shock, elevated intracranial pressure and perioperative fluid deficits. Infusion, however, causes electrolyte and acid-base imbalance. In a randomized double-blind study, the effects of a 10-min infusion of 4 ml/kg 7.5% NaCl or 0.9% NaCl were evaluated in 14 fasting women before hysterectomy. Venous blood from the forearm was collected at baseline, 10, 20, 30, 60 and 120 min after start of the infusion for the determination of plasma electrolytes and acid-base balance. We found that 1) a median increase in plasma sodium of 11 mmol/l (range 9-13 mmol/l) and chloride of 14 mmol/l (range 9-16 mmol/l) immediately after the infusion followed by a small decrease after 2 h, 2) a minor decrease in plasma potassium in relation to the infusion followed by a significant increase of 0.3 mmol/l (range 0.1-1.4 mmol/l) above baseline after 1 h, 3) a decrease in pH of 0.05 (range 0.02-0.07) and, finally, 4) a decrease in base excess of 1.9 mmol/l (range 0.8-2.7 mmol/l). It is concluded that infusion of 7.5% NaCl in a clinical relevant dose increases plasma potassium and causes minor changes in the acid-base balance in normovolaemic women.

Hypertonic Fluid Administration in Patients With Septic Shock

“…In our study and numerous other studies, hypertonic fluid administration in shock states has been shown to be safe, resulting in a transient increase in plasma sodium and chloride levels without evidence of harm and without a significant effect on the acid-base equilibrium (8,35).…”

Management of intracranial hypertension: Recent advances and future directions

“…[56][57][58] Electrolyte abnormalities are common, with hypernatremia, along with transient hypokalemia and metabolic acidosis secondary to bicarbonate poor fluid administration. 59 Central pontinemyelinosisthough is a theoretical concern, animal studies as well as clinical studies [60][61] do not show a clear association.Administration of HTS also poses a risk of thrombophlebitis especially with higher concentrations and prolonged infusions.Transient therapy with hyperosmolar fluids, however, does not cause thrombophlebitis, [62][63][64] so emergency administration may not be delayed for central venous access. Like mannitol, it may also cause rebound ICH, but the evidences are also less convincing.…”

Hypertonic Saline for the Treatment of Intracranial Hypertension

“…Other side effects of HTS infusion include phlebitis and venous thrombosis (if HTS is administered through a peripheral vein), and hyperchloremic acidosis after repeated doses. Hypokalemia can occur because of dilution and the exchange of sodium and potassium at the cellular level in the kidneys, followed by hyperkalemia due to acidosis [43]. This requires careful monitoring and treatment.…”