Hypertonic fluids

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Hi Michael,
The bottom line is few if any!
20 years of trials including several (Dubick, Wasser and Wade) looking specifically for serious side effects have ALL demonstrated that these products are safe, at least up to the current recommended limits of 4ml/Kg.
No reports of patients developing: overload (in fact they may be beneficial in heart failure by promoting a diuresis), pontine demyelination, ICP rebound, hypertension, allergic reactions (although have a look at Walter Mauritz's experiences with 50,000 units given, he has had a small number of reactions, but none serious)
Bottom line these products are safe and effective in resuscitation, the problem is do they improve outcome?......sadly, I don't think that we have any chance of seeing that trial in the foreseeable future.

Incidentally, HSD in our hands and anecdotally in several papers appears to cause a transient drop in BP before a much greater rise (? a dextran effect). We see this most in the ICU when patient has an arterial line and constant monitoring. This appears to be self-limiting, but can cause concern on first use. We have not seen this with HSS.

The only other side effect that we have seen has been a transient bradycardia if infiltrated rapidly, centrally. This has been explained in several ways including Na+ load in the right atrium or simply and atrial stretch effect, but we have never seen a brady tht needed intervention.

Finally, despite lots of pockets of enthusiasm the resus world in the UK is still dragging it's feet on this one, despite the evidence of safety, the effectiveness and the tremendous practical advantages. In view of this we are already losing the only HSD currently available and there is talk of the comapny withdrawing HSS unless sales improve. As a team that use nothing else in primary resuscitation we believe that this would be a great loss.

Cheers
Mark F
ATACC, UK


----- Original Message ----
From: Michael Krowka <mkrowka at gmail.com>
To: "Trauma & Critical Care mailing list" <trauma-list at trauma.org>
Sent: Tuesday, 5 June, 2007 6:22:05 AM
Subject: Hypertonic fluids


What are the specific downsides to hypertonic fluid administration? The
literature base seems to grow (specifically with HSD) without much devils
advocate.

What does the war-time data say?


Our thoughts go out to those involved in the crash.


Michael D. Krowka   


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