Letters to the Editor: Letters & Announcements
We agree with Shields and Winter’s comments on hypertonic saline and its effects on hemodynamic and cardiovascular functions and arterial pH after hemorrhagic shock. In addition, as observed in our study (1), the use of chloride as the anion in hypertonic saline solution resulted in hyperchloremia and maintained the metabolic acidosis that may have affected gut mucosal acidosis. In our study (1), lactated Ringer’s and hydroxyethyl starch solutions, but not hypertonic saline solution, corrected gastric pH to prehemorrhage levels in dogs. Hypertonic saline produces metabolic acidosis by increasing the plasma chloride concentration relative to the plasma sodium concentration (2). The result is a reduction in the strong ion difference—the difference between positively and negatively charged electrolytes—which, in turn, produces an increase in free hydrogen ions to preserve electrical neutrality.
However, we cannot agree that the hypertonic saline solution is the only resuscitation agent that has the potential to attenuate organ injury in the shocked state. Our research (1) shows that hypertonic saline is a good choice in these cases, but other solutions like lactated Ringer’s, hydroxyethyl starch, and hypertonic saline plus dextran are very good products in relation to systemic and regional oxygenations.
José Reinaldo Cerqueira Braz, MD, PhD
Luiz Antonio Vane, MD, PhD
Department of Anesthesiology
UNESP School of Medicine
Botucatu-São Paulo, Brazil
1. Braz JRC, do Nascimento P Jr, Paiva Filho O, et al. The systemic and gastrointestinal oxygenation effects of hemorrhage shock resuscitation with hypertonic saline and hypertonic saline 6% dextran-70: A comparative study in dogs. Anesth Analg 2004;99:536–46.
2. Prough DS, White RT. Acidosis associated with perioperative saline administration: Dilution or delusion? Anesthesiology 2000;93:1167–9.