Hemodynamic And Biochemical Changes In Early Resusciton Of Acute Hypovolemic Shock By Using Isotonic Versus Hypertonic Cystalloids

Conventional resuscitation of patients in hemorrhagic shock requires large amounts of fluids. Hypertoruc saline is advocated as an effective resuscitation fluid for hypovolemic shock and burns . It provides rapid resuscitation to more normal hemodynamic parameters with less total volwl1e resuscitated than standard crystalloid resuscitation fluids . Prolongation of improved hemodynamics using hypertonjc saline has been achieved by combirung it with dextran.The present study was carried out to compare the effects of hypertoruc solution ( hypertoruc saline dextran) and balanced saline solution ( Ringer’s lactate ) on hemodynamics, electrolytes, acid base changes and hematological changes during resuscitation of acute1) Hemodynamic parameters ( measured on admission, after 1/2 an hour and 2 hours of resuscitation ) including : arterial blood pressure, pulse rate, central venous pressure and respiratory rate .2) Urine output, osmolarity and electrolytes including Na and K (measured on admission, after 1 hour and 3 hours of resuscitation) .3) Serum electrolytes ( Na and K ) and osmolarity ( measured on admission, after 1/2 an hour and 2 hours of resuscitation) .4) Kidney function tests including blood urea and serum creatinine levels ( measured on admission and after 6 hours of resuscitation) .5) Blood sugar level ( measured on admission and after 2 hours of resuscitation) .6) Acid - base changes including HC03 and pH (measured on admission, after 1/2 an hour and 2 hours of resuscitation) .7) Hematocrit value ( measured on adnussion and after 2 hours of resuscitation) .8) Coagulation profile including prothrombin time and partial thromboplastin time ( measured after 6 hours of resuscitation) .The collected data \\fere statistically analysed with the following results:• Hemodynamics : there was a significant treatment effect in favour of hypertonic saline dextran on the systolic blood pressure, diastolic blood pressure , mean arterial blood pressure, heart rate, central venous pressure and respiratory rate .• Urine output improved more with HSD with illghJy significant statistical difference.• Serum sodium level and osmolarity increased in group 1 but gradually decreased without manifestations of hypernatrerrua as urine sodiwn level and urine osmolarity were illgher in the same group.• Serum potassium level decreased more with HSD than RL after 1/2 an hour and the difference was statistically signicicant but after 2 hours with gradual return to normal levels the difference became insignificant . The same changes were observed in urine potassium level.• No significant change in blood sugar and serwn creatinine levels in both groups. Blood urea level decreased in both groups with insignificant statistical difference.• Mildly prolonged PT and PTT in group 1 compared \\~th group 2 and the difference was statistically significant but without bleeding from the site of trauma or bleeding disorder.• The hematocrit value showed more decrease with HSD and the difference was statistically significant.• Serwn lactate level was lower In group 1 with significant difference indicating improvement of hemodynamics and decreased anerobic metabolism.From this work we concluded that hypertonic solution improves the hemodynamic state and reduces the anerobic metabolism of the hypovolemic shocked patients more effectively than Ringer’s lactate solution without hannful effects on the blood electrolytes, osmolarity , kidney function and blood sugar.