Hypertonic Resuscitation Fluids

Hypertonic saline (HS) has been recommended as a possible alternative fluid resuscitation therapy based upon impressive hemodynamic effects in numerous animal studies of acute hemorrhage. Given in small amounts and often in combination with 6% dextran 70, HS caused a prompt and sustained shift of fluid from the interstitial to the intravascular compartment. Based upon these studies, HS was once promoted as an ideal agent for the prehospital resuscitation of hemorrhage. Thus far, clinical studies have not demonstrated overall improvement in survival in victims of hypotensive trauma given HS. 2021 However, there was a trend toward improved outcome in some subpopulations of hypotensive trauma victims given HS. There may be particular injury patterns (such as combined hypovolemia and head injury) in which a benefit exists. Given the absence of a demonstrated benefit in the general population of hemorrhage patients, the widespread use of HS cannot be recommended because of uncommon but potentially significant complications. These include confusion, seizures, and central pontine myelinolysis. The addition of dextran also presents disadvantages, as it may induce anaphylactic reactions and coagulopathies.

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