Hypertonic saline 5% vs. lactated ringer for resuscitating patients in hemorrhagic shock

Though hypertonic and isotonic crystalloids are used nowadays in resuscitating patients in hemorrhagic shock, yet there is no sufficient data in support of either. The aim of this study was to compare the hemodynamic effects of hypertonic saline 5% and lactated ringer solutions when used for the resuscitation of patients in hemorrhagic shock.

In a double-blinded randomized clinical trial, sixty adult patients in hemorrhagic shock admitted to the Emergency Department of a teaching hospital between September 2005 and September 2006, were enrolled in this study. Patients were divided into two groups. The first group received lactated ringer 20 ml/kg, and the second group received 4 ml/kg of 5% hypertonic saline infused intravenously within 10 to 15 minutes followed by lactated ringer 10 ml/kg/hr. Hemodynamic parameters were measured at hospital admission as well as every 15 minutes for an hour; and the results were compared between the two groups.

Gastrointestinal bleeding was the most common cause of shock. There was a significant difference between the baseline and final hemodynamic parameters (MAP, HR, CVP) in each group; however, data of the two groups did not differ significantly. The PaO2 was higher in the lactated ringer group and there was no difference in PaCO2 neither in each group, nor between the two groups.

Both hyper and isotonic crystalloid solutions can improve hemodynamic status and the blood gas measurements, similarly; however, lactated ringer is a more potent solution in improving tissue oxygenation.