TREATMENT OF UNCONTROLLED HEMORRHAGIC-SHOCK WITH HYPERTONIC SALINE SOLUTION

  • 1 February 1990
    • journal article
    • research article
    • Vol. 170  (2) , 106-112
Abstract
Hypertonic saline solution (HTS) treatment of uncontrolled hemorrhagic shock (UCHS) induced by incision of three major branches of the ileocolic artery, leading to free intra-abdominal bleeding, was studied in rats. The rats were divided into two groups. In group 1, the abdominal wall was closed immediately after induction of hemorrhage and the rats were divided into six subgroups-1a, five untreated; 1b, treated with 5 milliliters per kilogram of sodium chloride 7.5 per cent (HTS) after five minutes; 1c, eight had HTS infused after 15 minutes; 1d, nine had HTS infused after 30 minutes; 1e, nine had HTS infused after 60 minutes, and 1f, nine had HTS infused after 120 minutes. In rats in group 2, the abdominal wall was kept open during HTS therapy and bleeding was estimated by the amount of sponges used to absorb shed blood. These rats were also divided into six subgroups-2a, five untreated; 2b, nine had HTS infused after five minutes; 2c, six had HTS infused after 15 minutes; 2d, six had HTS infused after 30 minutes; 2e, eight had HTS infused after 60 minutes, and 2f, six had HTS infused after 120 minutes. UCHS in group 1 was followed by a fall in the mean arterial pressure (MAP) from 99 to 46 torr (p < 0.001) in five minutes and a gradual rise to 63 torr (p < 0.01) after 30 minutes, with a survival rate of 80 per cent. HTS infusion five minutes after hemorrhage was followed by a further fall in MAP to 37 torr (p < 0.01) after 30 minutes and a mortality rate of 85.7 per cent (p < 0.01). HTS treatment after 15, 30, 60 and 120 minutes also led to a further fall in MAP and increased mortality. In group 2, the hemodynamic response to intra-abdominal vessel injury in untreated rats was similar to that of those in group 1 and the amount of sponges used to absorb shed blood was 2.4. After five, 60 and 120 minutes of HTS treatment, the hemodynamic response was similar to that in group 1. Five and one-half (p < 0.01), 3.5 and 3.0 sponges, respectively, were used to absorb shed blood. In the rats treated by HTS 15 minutes after the hemorrhagic insult, no increased bleeding was observed, the MAP rose to 75 torr (p < 0.01) with zero per cent mortality rate, and when HTS was given after 30 minutes, MAP rose to 81.7 torr (p < 0.01) with 16 per cent mortality rate. It is concluded that HTS treatment of UCHS led to increased intra-abdominal bleeding, fall in MAP and early mortality when HTS therapy was given within two hours after the hemorrhagic insult.