BLOOD-GLUCOSE AND LACTATE LEVELS DURING HEMORRHAGIC-SHOCK REVERSION BY HYPERTONIC NACL SOLUTION

1. Several studies have shown that in irreversible hemorrhagic shock t he liver is one of the first vital organs to present metabolic alterat ions accompanied by an increase in lacticemia. Intravenous infusion of hypertonic solutions increases mesenteric flow as well as liver perfu sion, an effect which can be blocked by vagotomy. 2. In the present st udy we investigate the possible role of the increase in mesenteric flo w in the prevention of hepatic failure evaluated by the arterial-venou s difference in the generation of glucose from lactate during the reve rsal of hemorrhagic shock with hypertonic NaCl solution and the possib le blockage of this response by bilateral vagotomy. 3. Twenty-eight ma le dogs, weighing 14-20 kg, were submitted to severe hemorrhagic shock . The animals were then divided into four groups: a) HYPER, 2400 mosm/ l NaCl; b) SALINE, 300 mosm/l NaCl; c) HYPERVg, 2400 mosm/l NaCl immed iately after bilateral vagotomy; d) SALINEVg, 300 mosm/l NaCl immediat ely after bilateral vagotomy. Each group received an intravenous infus ion of 10% of the shed blood volume of NaCl infusion. 4. Arterial and venous samples were collected to monitor the levels of lactate, glucos e and insulin. During hemorrhage, arterial and venous lactate concentr ations increased. After infusion, lactate levels decreased from 332 +/ - 23% to 115 +/- 12% in the HYPER group in contrast to the SALINE grou p where it increased from 327 +/- 20% to 422 +/- 19%. 5. The decrease in arterial lactate observed after hypertonic solution infusion (2400 mosm/l), in dogs with intact vagus, suggests an increase of lactate up take by heart and liver. Thus the beneficial effect of hypertonic solu tion in the reversal of hemorrhagic shock may be to enhance blood flow and oxygen delivery to the liver which would maintain glucose product ion and prevent hepatic failure. All the metabolic effects of hyperton ic solution were abolished by vagotomy.