• W Furtwängler, D Balogh, A Pomaroli, J Koller, C Wieser, and P Mair.
• Universitätsklinik für Anaesthesie und Allgemeine Intensivmedizin, Innsbruck.
• Anaesthesist. 1990 Oct 1; 39 (10): 499-504.

AbstractSmall-volume resuscitation with hypertonic saline in combination with dextran appears to be very successful in experimental animals, where better results are achieved than in animals treated with a traditional infusion regime. This effect is apparently related to improved organ blood flow due to reflex vasodilatation. This reflex is based on the arrival of hypertonic solution in the pulmonary circulation. The expansion of intravascular volume would seem to be of secondary importance. Atrial natriuretic peptide (ANP) is released from secretory granules located in atrial cardiocytes. Atrial distention appears to be the predominant stimulus triggering ANP production. In addition to the natriuretic and diuretic effects, ANP leads to vasodilation, especially when vascular tone is elevated; the sympathetic reflex seems to be attenuated. Cyclic Guanosine Monophosphate (cGMP) is an intracellular messenger and is partly released by ANP in the membrane-bound form. Renin excretion is highly influenced by ANP. The object of this study was to evaluate the influence of a hypertonic solution on this hormonal regulatory system. METHOD. This study compared a hypertonic sodium chloride solution (7.5%) in combination with hydroxyethyl starch (6%) (HH) to Ringer's lactate (RL). Six healthy volunteers received 4 ml/kg HH and 1 week later 500 ml RL. The infusion was administered in 20 minutes via a central venous catheter 70 cm in length. Blood pressure, heart rate, hemoglobin (Hb), hematocrit (Hk), colloid osmotic pressure (COP), sodium (Na+), chloride (Cl-), and plasma osmolarity were measured before starting and 5 and 30 min following infusion. At the same times ANP, cGMP, and plasma renin were also determined. RESULTS. Both groups showed no change in blood pressure or heart rate. The decrease of Hb, Hk, and COP in the HH and RL groups indicated the expansion of circulating plasma volume. HH infusion caused significant increases in ANP and cGMP, whereas plasma renin declined significantly. After RL infusion, ANP and renin values were very similar to the HH group except in one volunteer, who showed an extreme increase in ANP (760 pg/ml) 5 min after HH infusion. cGMP did not increase significantly in the RL group. On comparison of the two groups, only a significant difference in plasma osmolarity and in sodium and chloride levels was noted. CONCLUSION. We found that hypertonic NaCl (7.5%) with HH was well tolerated. Release of ANP and cGMP after HH infusion in healthy volunteers was not as high as expected, and the vasodilatory effect of hypertonic solutions was not explained by ANP or cGMP release in this investigation.

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