HYPERTONIC SODIUM RESUSCITATION IS ASSOCIATED WITH RENAL-FAILURE AND DEATH

Objective The use of hypertonic sodium solutions (HSS) and lactated Ri nger's (LR) solution in the resuscitation of patients with major burns was compared. Summary Background Data Hypertonic sodium solutions hav e been recommended for burn resuscitation to reduce the large total vo lumes required with isotonic LR solution and their attendant complicat ions. Methods To evaluate the efficacy of this therapy in our adult bu rn center, we resuscitated 65 consecutive patients with HSS (290 mEq/L Na) between July 1991 and June 1993 and compared them with 109 burn p atients resuscitated with LR (130 mEq/L Na) between July 1986 and June 1988 (LR-1). A subsequent 39 patients were resuscitated with LR betwe en September 1993 and August 1994 (LR-2). Results Patients receiving h ypertonic sodium solutions versus LR-1 were similar with respect to ag e (46.0 vs. 43.6 years), total burn size (39.2% vs. 39.9%), incidence of inhalation injury (41.5% vs. 47.7%), and predicted mortality (34.6% vs. 30.2%). Total resuscitation volumes during the first 24 hours wer e lower among patients treated with HSS than those in the LR-1 group ( 3.9 +/- 0.3 vs. 5.3 +/- 0.2 mL/kg/%body surface area [BSA], p < 0.05). After 48 hours, however, cumulative fluid loads were similar (6.6 +/- 0.6 vs. 7.5 +/- 0.3 mL/kg/%BSA), and total sodium load was greater wi th the HSS group (1.3 +/- 0.1 vs. 0.9 +/- 0.1 mEq/kg/%BSA, p < 0.002). During the first 3 days after burn, serum sodium concentrations were moderately elevated in the HSS patients (153 +/- 2 vs. 135 +/- 1 mEq/L , p < 0.001). Patients resuscitated with HSS had a fourfold increase i n renal failure (40.0 vs. 10.1%, p < 0.001) and twice the mortality of LR-1 patients (53.8 vs. 26.6%, p < 0.001). In patients resuscitated w ith HSS, renal failure was an independent risk factor (p < 0.001, by l ogistic regression). Analysis of these results prompted a return to LR resuscitation (LR-2). Age (41.6 +/- 2.9 years), burn size (37.8 +/- 3 .9 %BSA), and incidence of inhalation injury (51.3%) were similar to t he earlier groups. Total sodium load was less among LR-2 patients than the HSS group (0.7 +/- 0.1 mEq/kg/%BSA, p < 0.01), but similar to the LR-I patients. Renal failure developed in only 15.4%, and 33.3% died, similar to the LR-1 group and significantly lower than patients treat ed with HSS (p < 0.001 and p < 0.05, respectively). Conclusion Hyperto nic sodium solution resuscitation of burn patients did not reduce the total resuscitation volume required. Furthermore, it was associated wi th an increased incidence of renal failure and death. The use of HSS f or burn resuscitation may be ill advised.