Abstract
Intravenous fluids vary in oncotic pressure, osmolarity, and tonicity. Osmotically active particles attract water across semipermeable membranes until equilibrium is attained. The osmolarityof a solution, which quantifies the forces determining the distribution of water, refers to the number of osmotically active particles per liter of solution. In contrast, osmolalityis a measurement of the number of osmotically active particles per kilogramof solvent. The osmolality of body fluids can be estimated as follows:
where [Na + ] is expressed in mEq 1−1, serum glucose is expressed in mg-dl−1, and BUN is expressed in mg-dl−1 respectively. Urea, sugars, alcohols, and radiographic dyes that increase osmolality may increase the measured value, generating an increased “osmolal gap” between the calculated and measured values. Osmotic activity can also be expressed in terms of osmotic pressure, a measure of the attraction for water exerted across a semipermeable membrane. Osmotic pressure is approximated from the equation [1]:
A hyperosmolar state occurs whenever the concentration of osmotically active particles is high. Thus, uremia (increased BUN) and hypernatremia (increased serum sodium) increase both serum osmolality and osmolarity. However, because urea distributes throughout total body water, an increase in BUN, unlike an increase in [Na + ], does not cause hypertonicity, i.e. osmotically mediated redistribution of water from intracellular volume (ICV) to extracellular volume (ECV). The term “tonicity” is also used colloquially to compare the osmotic pressure of a solution to that of plasma. A fluid in which the osmotic pressure is similar to that of plasma; is termed isotonic. Hypotonie solutions exert lower osmotic pressures than plasma; hypertonic solutions exert higher osmotic pressures (Table 1).
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
Preview
Unable to display preview. Download preview PDF.
References
Guyton AC (1981) Textbook of Medical Physiology, 6th edn. WB Saunders, Philadelphia
Zornow MH, Todd MM, Moore SS (1987) The acute cerebral effects of changes in plasma osmolality and oncotic pressure. Anesthesiology 67:936–941
Tommasino C, Moore S, Todd MM (1988) Cerebral effects of isovolemic hemodilution with crystalloid or colloid solutions. Crit Care Med 16:862–868
Poole GV Jr, Prough DS, Johnson JC, Stullken EH, Stump DA, Howard G (1987) Effects of resuscitation from hemorrhagic shock on cerebral hemodynamics in the presence of an intracranial mass. J Trauma 27:18–23
Maningas PA, De Guzman LR, Tillman FJ, et al. (1986) Small-volume infusion of 7.5 NaCl in 6% Dextran 70 for the treatment of severe hemorrhagic shock in swine. Ann Emerg Med 15:1131–1137
Weed LH, McKibben PS (1919) Experimental alteration of brain bulk. Am J Physiol 48:531–561
Wilson BJ, Jones RF, Coleman ST, Moyer CA (1951) The effects of various hypertonic sodium salt solutions on asternal pressure. Surgery 30:361–366
Baue AE, Tragus ET, Parkins WM (1967) Effects of sodium chloride and bicarbonate in shock with metabolic acidosis. Am J Physiol 212:54–60
Jelenko C III, Wiiliams JB, Wheeler ML, et al. (1979) Studies in shock and resuscitation. I. Use of a hypertonic, albumin-containing fluid demand regimen (HALFD) in resuscitation. Crit Care Med 7:157–167
Monafo WW, Chuntrasakul C, Ayvazian VH (1973) Hypertonic sodium solutions in the treatment of burn shock. Am J Surg 126:778–783
Monafo WW (1970) The treatment of burn shock by the intravenous and oral administration of hypertonic lactated saline solution. J Trauma 10:575–586
Liang CS, Hood WB Jr (1978) Mechanism of cardiac output response to hypertonic sodium chloride infusion in dogs. Am J Physiol 235:18–22
Shackford SR, Sise MJ, Fridlund PH, et al. (1983) Hypertonic sodium lactate versus lactated Ringer’s solution for intravenous fluid therapy in operations on the abdominal aorta. Surgery 94:41–51
Velasco IT, Pontieri V, Rocha e Silva MR Jr, Lopes OU (1980) Hyperosmotic NaCl and severe hemorrhagic shock. Am J Physiol 239:664–673
Layon J, Duncan D, Gallagher TJ, Banner MJ (1987) Hypertonic saline as a resuscitation solution in hemorrhagic shock: Effects on extravascular lung water and cardiopulmonary function. Anesth Analg 66:154–158
Ljungqvist O, Boija PO, Ware J (1989) The effect of hyperosmolar infusions on survival after hemorrhage. Acta Chir Scand 155:433–438
Lopes OU, Pontieri V, Rocha e Silva MR Jr, Velasco IT (1981) Hyperosmotic NaCl and severe hemorrhagic shock: Role of the innervated lung. Am J Physiol 241:883–890
Younes RN, Aun F, Tomida RM, Birolini D (1985) The role of lung innervation in the he-modynamic response to hypertonic sodium chloride solutions in hemorrhagic shock. Surgery 98:900–906
Schertel ER, Valentine AK, Rademakers AM, Muir WW (1990) Influence of 7% NaCl on the mechanical properties of the systemic circulation in the hypovolemic dog. Circ Shock 31:203–214
Spital A, Sterns RD (1989) The paradox of sodium’s volume of distribution. Why an extracellular solute appears to distribute over total body water. Arch Intern Med 149:1255–1257
Onarheim H, Missavage AE, Kramer GC, Gunther RA (1990) Effectiveness of hypertonic saline-dextran 70 for initial fluid resuscitation of major burns. J Trauma 30:597–603
Gunn ML, Hansbrough JF, Davis JW, Furst SR, Field TO (1989) Prospective, randomized trial of hypertonic sodium lactate versus lactated Ringer’s solution for burn shock resuscitation. J Trauma 29:1261–1267
Prough DS, Johnson JC, Stump DA, Stullken EH, Poole GV Jr, Howard G (1986) Effects of hypertonic saline versus lactated Ringer’s solution on cerebral oxygen transport during resuscitation from hemorrhagic shock. J Neurosurg 64:627–632
Johnston WE, Alford PT, Prough DS, Howard G, Royster RL (1985) Cardiopulmonary effects of hypertonic saline in canine oleic acid-induced pulmonary edema. Crit Care Med 13:814–817
Boldt J, Kling D, Herold C, Dapper F, Hempelmann G (1990) Volume therapy with hypertonic saline hydroxyethyl starch solution in cardiac surgery. Anaesthesia 45:928–934
Smith GJ, Kramer GC, Perron P, Nakayama S, Gunther RA, Holcroft JW (1985) A comparison of several hypertonic solutions for resuscitation of bled sheep. J Surg Res 39:517–528
Vassar MJ, Perry CA, Holcroft JW (1990) Analysis of potential risks associated with 7.5% sodium chloride resuscitation of traumatic shock. Arch Surg 125:1309–1315
Todd MM, Tommasino C, Moore S (1985) Cerebral effects of isovolemic hemodilution with a hypertonic saline solution. J Neurosurg 63:944–948
Prough DS, Johnson JC, Poole GV Jr, Stullken EH, Johnston WE, Royster R (1985) Effects in intracranial pressure of resuscitation from hemorrhagic shock with hypertonic saline versus lactated Ringer’s solution. Crit Care Med 13:407–411
Zornow MH, Scheller MS, Shackford SR (1989) Effect of a hypertonic lactated Ringer’s solution on intracranial pressure and cerebral water content in a model of traumatic brain injury. J Trauma 29:484–488
Prough DS, Whitley JM, Taylor CL, Deal DD, De Witt DS (1991) Regional cerebral blood flow following resuscitation from hemorrhagic shock with hypertonic saline: Influence of a subdural mass. Anesthesiology 75:319–327
Gunnar W, Jonasson O, Merlotti G, Stone J, Barrett J (1988) Head injury and hemorrhagic shock: Studies of the blood-brain barrier and intracranial pressure after resuscitation with normal saline solution, 3% saline solution, and dextran-40. Surgery 103:398–407
Gunnar W, Kane J. Barrett J (1989) Cerebral blood flow following hypertonic saline resuscitation in an experimental model of hemorrhagic shock and head injury. Braz J Med Biol Res 22:287–289
Ducey JP, Mozingo DW, Lamiell JM, Okerburg C, Gueller GE (1989) A comparison of the cerebral and cardiovascular effects of complete resuscitation with isotonic and hypertonic saline, hetastarch, and whole blood following hemorrhage. J Trauma 29:1510–1518
Gunnar WP, Merlotti GJ, Barrett J, Jonasson O (1986) Resuscitation from hemorrhagic shock: Alterations of the intracranial pressure after normal saline, 3% saline and dextran-40. Ann Surg 204:686–692
Prough DS, De Witt DS, Taylor CL, Deal DD, Vines SM (1991) Hypertonic saline does not reduce intracranial pressure or improve cerebral blood flow after experimental head injury and hemorrhage in cats. Anesthesiology 75:A544
Shoemaker WC, Appel PL, Kram HB, Waxman K, Lee TS (1988) Prospective trial of supra-normal values of survivors as therapeutic goals in high-risk surgical patients. Chest 94:1176–1186
Whitley JM, Prough DS, Brockschmidt JK, Vines SM, De Witt DS (1991) Cerebral hemody-namic effects of fluid resuscitation in the presence of an experimental intracranial mass. Surgery 110:514–522
Miller JD, Butterworth JF, Guideman SK, et al. (1981) Further experience in the management of severe head injury. J Neurosurg 54:289–299
Shackford SR, Fortlage DA, Peters RM, Hollingsworth-Fridlund P, Sise MJ (1987) Serum osmolar and electrolyte changes associated with large infusions of hypertonic sodium lactate for intravascular volume expansion of patients undergoing aortic reconstruction. Surg Gyne-col Obstet 164:127–136
Norenberg MD, Leslie KO, Robertson AS (1982) Association between rise in serum sodium and central pontine myelinolysis. Ann Neurol 11:128–135
Laureno R (1983) Central pontine myelinolysis following rapid correction of hyponatremia. Ann Neurol 13:232–242
Norenberg MD, Papendick RE (1984) Chronicity of hyponatremia as a factor in experimental myelinolysis. Ann Neurol 15:544–547
Mazzoni MC, Borgstrom P, Arfors KE, Intaglietta M (1990) The efficacy of iso-and hyper-osmotic fluids as volume expanders in fixed-volume and uncontrolled hemorrhage. Ann Emerg Med 19:350–358
Gross D, Landau EH, Klin B, Krausz MM (1990) Treatment of uncontrolled hemorrhagic shock with hypertonic saline solution. Surg Gynecol Obstet 170:106–112
Prough DS, Johnston WE: Fluid resuscitation in septic shock: No solution yet. Anesth Analg 1989; 69:699
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 1992 Springer-Verlag Berlin Heidelberg
About this paper
Cite this paper
Prough, D.S., De Witt, D.S. (1992). Cerebrovascular Effects of Hypertonic Resuscitation. In: Vincent, JL. (eds) Yearbook of Intensive Care and Emergency Medicine 1992. Yearbook of Intensive Care and Emergency Medicine, vol 1992. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-84734-9_53
Download citation
DOI: https://doi.org/10.1007/978-3-642-84734-9_53
Publisher Name: Springer, Berlin, Heidelberg
Print ISBN: 978-3-540-55241-3
Online ISBN: 978-3-642-84734-9
eBook Packages: Springer Book Archive