Assessment of renal hemodynamic toxicity of fluid challenge with 0.9% NaCl compared to balanced crystalloid (PlasmaLyte®) in a rat model with severe sepsis

Abstract

BackgroundAccording to international guidelines, volume expansion with crystalloids is the first-line treatment for hemodynamic management in patients with severe sepsis or septic shock. Compared to balanced crystalloids, 0.9% sodium chloride (0.9% NaCl) induces hyperchloremia and metabolic acidosis and may alter renal hemodynamics and function. We compared the effects of 0.9% NaCl to a less chloride-concentrated fluid, PlasmaLyte® (PL) in targeted fluid resuscitation in a randomized, double-blind controlled study in an experimental model of severe sepsis in rats.ResultsA sepsis with hypotension was induced by cecal ligature and puncture (CLP) in 40 male Wistar rats (20 for each crystalloid). Rats received fluid resuscitation over a period of 200 min for a targeted mean arterial pressure of 90 mm Hg. Animals received similar volumes of 0.9% NaCl or PL. Unlike PL-resuscitated rats, 0.9% NaCl-resuscitated rats experienced hyperchloremia and metabolic acidosis, whereas systemic hemodynamics, renal hemodynamics and renal function were not significantly different between both groups.ConclusionIn our model of rats with severe sepsis resuscitated with large amounts of crystalloids, 0.9% NaCl-induced hyperchloremic acidosis, but balanced crystalloid did not improve systemic and renal hemodynamics or renal function.Electronic supplementary materialThe online version of this article (doi:10.1186/s13613-017-0286-1) contains supplementary material, which is available to authorized users.

Hyperchloremia is not associated with AKI or death in septic shock patients: results of a post hoc analysis of the “HYPER2S” trial

“…Comparing NaCl solutions of different chloride concentrations, animal studies have suggested that infusing a chloride-rich solution, directly into the renal artery, critically determined changes in renal blood flow due to intra-renal vasoconstriction [31, 32]. This finding was not confirmed in a more relevant animal model of sepsis resuscitated with large amounts of crystalloids [33]. Compared to a balanced solution, normal saline induced hyperchloremia and acidosis; however, no difference was found for renal hemodynamics and function [33].…”

“…This finding was not confirmed in a more relevant animal model of sepsis resuscitated with large amounts of crystalloids [33]. Compared to a balanced solution, normal saline induced hyperchloremia and acidosis; however, no difference was found for renal hemodynamics and function [33]. Moreover, decreased renal blood flow velocity and cortical tissue perfusion have been reported in healthy volunteers after infusion of 2L of saline [34].…”

Serum chloride levels in critical illness—the hidden story

“…There is some animal [ 11 , 14 , 47 ] and human data (13) that suggest that renal blood flow and renal cortical perfusion is diminished under chloride infusion. However, a recently published trial [ 56 ] does not confirm these findings.…”

Hospital-Acquired Serum Chloride Derangements and Associated In-Hospital Mortality

“…The administration of chloride-rich crystalloids is one of the most common causes of iatrogenic hospital-acquired hyperchloremia, particularly in critically ill patients. Several animal and human studies have demonstrated that an infusion of 0.9% saline is associated with increased serum chloride levels [ 6 , 15 , 16 , 17 ]. Other hospital-acquired etiologies for dyschloremia include hyperchloremia induced by hospital diarrhea or diabetes insipidus and hypochloremia associated with diuretic use, congestive heart failure, nasogastric tube drainage, and vomiting [ 1 ].…”