The comparative effects of 3% saline and 0.5M sodium lactate on cardiac function: a randomised, crossover study in volunteers

Marek Nalos (1) , Euguenia Kholodniak , Louise Smith , Sam Orde , Iris Ting (1) , Michel Slama (2, 3) , Ian Seppelt (1) , Anthony S. Mclean , Stephen Huang

1 Department of Intensive Care Medicine
2 CHU Amiens-Picardie
3 MP3CV - Mécanismes physiopathologiques et conséquences des calcifications vasculaires - UR UPJV 7517

Objective: To investigate the metabolic and cardiac effects of intravenous administration of two hypertonic solutions - 3% saline (SAL) and 0.5M sodium lactate (LAC). Design, setting and participants: A randomised, double-blind, crossover study in ten human volunteers. Intravenous bolus of either SAL or LAC at 3 mL/kg over 20 min followed by a 2 mL/kg infusion over 60 min. Main outcome measures: Acid base parameters and echocardiographic indices of cardiac function, cardiac output (CO), left ventricular ejection fraction (LVEF) and mitral annular peak systolic velocity (Sm) before and after infusion of SAL or LAC. Results: Despite haemodilution, we observed an increase in sodium (139 +/- 2 mmol/L to 142 +/- 2 mmol/L in both groups) and respective anions, chloride (106 +/- 2 mmol/L to 112 +/- 3 mmol/L) and lactate (1.01 +/- 0.28 mmol/L to 2.38 +/- 0.38 mmol/L) with SAL and LAC, respectively. The pH (7.37 +/- 0.03 to 7.45 +/- 0.03; P < 0.01) and simplified strong ion difference (SID) (36.3 +/- 4.6 mmol/L to 39.2 +/- 3.6 mmol/L; P < 0.01) increased during the LAC infusion. The pH was unchanged, but SID decreased during SAL infusion (36.3 +/- 2.5 mmol/L to 33.9 +/- 3.1 mmol/L; P = 0.01). Both solutions led to an increase in preload and cardiac function, CO (4.36 +/- 0.79 Umin to 4.98 +/- 1.37 L/min v 4.62 +/- 1.30 Umin to 5.13 +/- 1.44 Umin), LVEF (61 +/- 6% to 63 +/- 8% v 64 6% to 68 +/- 7 %). The averaged Sm improved in the LAC group as compared with the SAL group (0.088 +/- 0.008 to 0.096 +/- 0.016 v 0.086 +/- 0.012 to 0.082 +/- 0.012; P = 0.032). Conclusions: The administration of SAL or LAC has opposing effects on acid base variables such as SID. Hypertonic fluid infusion lead to increased cardiac preload and performance with Sm, suggesting better left ventricular systolic function during LAC as compared with SAL. Lactated hypertonic solutions should be evaluated as resuscitation fluids.

Domaines: Sciences du Vivant [q-bio]

Marek Nalos, Euguenia Kholodniak, Louise Smith, Sam Orde, Iris Ting, et al.. The comparative effects of 3% saline and 0.5M sodium lactate on cardiac function: a randomised, crossover study in volunteers. Critical care and resuscitation, 2018, 20 (2), pp.124-130. ⟨hal-03584149⟩