Influence of hypertonic saline solution infusion on defibrillation efficacy

BACKGROUND: Transplantation of lung allografts from the same donor into 2 recipients ("twinning") provides an opportunity to study recipient and donor factors that influence early allograft function. METHODS: Twenty-seven pairs of recipients were identified and evaluated using multivariate logistic regression analysis (p < 0.05). Four measures of early graft function were analyzed: alveolar-arterial gradient in the operating room, first alveolar-arterial gradient in the intensive care unit, alveolar-arterial gradient at 24 hours, and days of mechanical ventilation. RESULTS: Analysis of the pooled data without regard to pairing showed that alveolar-arterial gradient in the operating room was influenced by donor age, length of donor hospitalization, recipient mean pulmonary artery (PA) pressure at unclamping, and transplantation of a left lung. The alveolar-arterial gradient in the intensive care unit was correlated with donor age, donor cause of death, and mean PA pressure on arrival in that unit. Only mean PA pressure remained significant at 24 hours. Days of mechanical ventilation was determined by mean PA pressure on arrival in the intensive care unit, drop in mean PA pressure during operation, and diagnosis of the recipient. In the paired analysis, receiving a left lung, recipient diagnosis (pulmonary hypertension worse than others), and need of cardiopulmonary bypass were significantly associated with immediate graft dysfunction, although these influences did not persist beyond the immediate postoperative period. Donor arterial oxygen tension and time of ischemia were not significant predictors in any analysis. CONCLUSIONS: Immediate allograft function was associated with donor-related characteristics initially, but these lost importance over the ensuing 24 hours. Recipient PA pressure was an immediate and persisting influence. In the analysis of differences in function between the members of each pair, transplantation of the left lung, recipient diagnosis, and cardiopulmonary bypass were identified, but their influence did not persist beyond the first 6 hours.     

Effect of portal infusion of hypertonic saline on neurons in the dorsal motor nucleus of the vagus in the rat

Effects of hepatoportal osmo-receptive (or sodium-receptive) afferents on neurons within the dorsal motor nucleus of the vagus (DMV) were investigated electrophysiologically in urethane-chloralose anesthetized rats. Responses of 56 spontaneously active neurons to antidromic stimulation of the ventral trunk of the subdiaphragmatic vagus were recorded in the left DMV. Among them, 35 neurons were inhibited by electrical stimulation of the hepatic branch of the vagus nerve (inhibitory neurons), except two neurons that were slightly excited. Effects of portal infusion of 3.6% NaCl were examined on 26 inhibitory neurons. Sixteen neurons increased their discharge rates and one neuron decreased its discharge rate in response to portal infusion of hypertonic saline. Thirty-five right DMV neurons responded to electrical stimulation of the dorsal trunk of the subdiaphragmatic vagus were inhibited by electrical stimulation of the hepatic branch of the vagus. Four neurons were excited by this stimulation. Relatively smaller number of neurons (5 out of 22 inhibitory neurons) increased their discharge rates in response to portal infusion of hypertonic saline. In conclusion, the response of DMV neuron observed in this experiment was characterized by increasing the frequency of spike discharges in response to portal infusion of hypertonic saline. However, these neurons were inhibited by electrical stimulation of the hepatic branch of the vagus nerve. These results suggest that the hepatoportal osmo-receptive afferents may be conveyed to the DMV via inhibitory synapses.     

Effect of infusion of hypertonic saline solution of conscious heifers with hypoxemia caused by endotoxin infusion

Thirty male Sprague-Dawley rats were given ciclosporin (Cs) orally, 15 mg/kg daily for 80 days. Fifteen served as positive controls, while the other 15 were given daily colchicine at a dose of 30 microg/kg in addition to Cs. Additional 15 rats were given olive oil only and served as negative controls. The animals were subjected every other week to laboratory assessment of serum creatinine, sodium, potassium, and Cs whole-blood trough levels; also urine samples were examined for creatinine, sodium, potassium, and protein concentrations. At the end point, the animals were sacrificed, and kidney tissue was examined for histopathological changes. Comparing negative control versus Cs-treated and Cs-plus-colchicine-treated rats, there were no significant differences in serum creatinine, creatinine clearance, and serum and urine values of sodium and potassium as well as urinary protein/creatinine ratios. Yet histopathological examination of kidney tissues showed focal tubular atrophy and interstitial fibrosis in inner medulla and inner stripe of the outer medulla in all Cs-treated animals and in only 1 of the colchicine-treated group, but in none of the negative controls. Histological changes in other kidney zones in different animal groups were minor and not different. From this study, we may conclude that colchicine is of protective value against chronic Cs nephrotoxicity in Sprague-Dawley rats.     

Effects of local pressure and vibration on muscle pain from eccentric exercise and hypertonic saline

In human subjects the triceps surae of one leg was exercised eccentrically by asking subjects to walk backwards on an inclined treadmill. Before the exercise controlled local pressure, applied to the muscle with an electromagnet, produced mild soreness, which was reduced when the pressure was combined with vibration. When delayed-onset muscle soreness (DOMS) had set in, 24-48 h after the exercise, vibration increased pain from local pressure. Vibrating at different frequencies suggested 80 Hz as the optimal frequency. During 2-h testing post-exercise, evidence of a change in character of the effects of vibration was first detected at 6 h. It persisted up to 72 h post-exercise. When muscle pain was generated in an unexercised triceps by injection of hypertonic (5%) saline, controlled local pressure applied to the sore area increased pain levels by 32% while pressure plus vibration reduced this to 11%. In a subject with DOMS, local pressure again increased pain from saline by 32% but combining it with vibration increased pain further by an additional 20%. The effect of vibration on DOMS could be abolished with a large nerve fibre block applied to the sciatic nerve. It is concluded that the vibration effects are the result of stimulation of large-diameter mechanoreceptive afferents in the muscle which, it is speculated, play a role in generating DOMS.     

Serial determinations of cerebral water content by magnetic resonance imaging after an infusion of hypertonic saline

We have determined the genomic structure and organization of the mouse Cenpa and Cenpc genes. CENPA is a member of the histone H3-like proteins and is thought to replace histone H3 in centromeric nucleosomes. CENPC is a DNA-binding protein that is located at the inner kinetochore plate of active mammalian centromeres. The Cenpa cDNA encodes a 134-amino-acid product that is 70% identical and 84% similar to its human homolog. The mouse Cenpa gene is approximately 8 kb in length and contains five exons. Sequence analysis of the 5' DNA sequence of the gene revealed two consensus CAAT boxes, a putative TFIID-binding site, an Sp1-binding domain, and two cell cycle regulatory motifs, but no consensus TATA element. The mouse Cenpc gene spans 60 kb and contains 19 exons that range in size from 44 to 602 bp. Sequence analysis of the C+G-rich promoter region showed the presence of known promoter elements, including a CpG island, a CAAT box, and several GC boxes, but the absence of a consensus TATA element.     

Glucose and maltodextrin in enteral diets have different effects on jejunal absorption of nutrients, sodium and water and on flow rate in mini pigs

BACKGROUND: The effect of altitude on subjects between 8 to 22 and 23 to 51 years, that resided at sea level, or in the highlands, and developed altitude lung edema, is presented in series of 21 prospective registered patients at 4,800 to 5,000 m altitude in the Andes mountains of Ecuador. PATIENTS MATERIAL AND METHODS: The 21 sick patients were evaluated at 2 h and at 8 hr after exposition to the high altitude. They were immediately evacuated from the high altitudes. Clinical and radiological methods were used. The statistical analysis was performed with chi(2) test with Yates correction and relative risk. RESULTS: The younger patients tended to develop illness with a higher frequency (p < 0.01). The place of residence influenced the development of the illness only for the group of persons between the ages of 23 to 51 years (p < 0.03); and also in comparing all of the subjects from the coast with those from the highlands. CONCLUSIONS: A inverse relationship was found between the age and the possibility of the development of altitude pulmonary edema, possibly due t a basic incrementation of the pressure of the pulmonary artery, or because of a relative immaturity of the adaptative mechanisms. The place of residence was significantly associated with a higher frequency of pulmonary edema in persons between the ages of 23 to 51 years.     

Effects of desalivation on drinking and air licking induced by water deprivation and hypertonic saline injections.

Previous studies show that desalivate (DS) rats drink more water than controls when maintained on a diet of dry food, but drink less than controls after a period of water deprivation. In the present series of studies, a total of 14 male and 2 female naive hooded rats served as Ss. Results show that DSs ate less food than sham operates (SHs), indicating that DSs' body fluids probably do not become as hyperosmotic as those of the SHs. When Ss were maintained on a moist mash during water deprivation, subsequent water intake and air licking were about the same for DSs and SHs. After combined food and water deprivation, both groups air-licked at greatly reduced rates. After subcutaneous injections of hypertonic saline, DSs air-licked just as much as SHs. It is concluded that DSs drink less after water deprivation because they eat less dry food than SHs during deprivation. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Induction of second trimester abortion by infusion of intraamniotic hypertonic and extraamniotic physiological saline solution (author's transl)

In a group of 84 women in the second trimester of pregnancy abortion was induced by intramniotic transabdominal instillation of 20 per cent NaCl. In a second group of 91 women the abortion was induced by means of extraamniotic physiological infusion of saline solution. The only complication observed in the first group was an increasing fever. In the second group there were better results. The fetus abortion was complete and in a shorter time. We assume that the new method is the method of choice because it gives no complications and may be easily performed. It may be used also in cases of missed abortion or intrauterine fetal death.     

Effect of hypertonic saline on leukocyte activity after spinal cord injury

STUDY DESIGN: The effect of intravenous administration of hypertonic saline on leukocyte adhesion after compression injury of the spinal cord was evaluated. OBJECTIVES: To investigate changes in leukocyte adhesion after spinal cord injury and to evaluate the effect of hypertonic saline on this process. SUMMARY OF BACKGROUND DATA: Leukocytes have been thought to exacerbate tissue injury after ischemia-reperfusion. Downregulating and reducing the number of circulating leukocytes has attenuated tissue damage in various models of cerebral ischemia. Recently, investigators have reported that leukocytes exacerbate injury in the spinal cord after trauma. Other recent findings have indicated that hypertonic saline may play a role in decreasing leukocyte adhesion and activation. METHODS: Sprague-Dawley rats were anesthetized, and a C3-C5 laminectomy was performed. Injury was caused by 35 g of compression applied to the cord for 10 minutes. Animals were divided into three groups: sham treated, untreated, and treated. The treated animals received 7.5% hypertonic saline (5 mL/kg, intravenously) 5 minutes after the injury. Sticking leukocytes and shear rate were measured using fluorescence microscopy. RESULTS: Administration of 7.5% hypertonic saline after injury significantly decreased the number of sticking leukocytes in the venules and arterioles. Shear rate was unchanged between the groups. CONCLUSIONS: The results show that an increase in leukocyte adhesion after a compressive injury is attenuated by the administration of 7.5% hypertonic saline. The decrease in adhesion cannot be attributed to changes in the shearing forces, because no significant change was observed in the shear rate. Hypertonic saline may interfere with leukocytes directly by interfering with their ability to swell and thus may prevent activation.     

Comparison of hypertonic saline solutions and dextran in dialysis-induced hypotension

The efficacy of three hypertonic saline solutions for treating dialysis-induced hypotension in a randomized, blinded, crossover clinical trial of 10 patients (a minimum of three cycles per solution) was compared. Dialysis-induced hypotension, defined as a decrease in systolic blood pressure of at least 10 mm Hg or systolic blood pressure less than 100 mm Hg, was treated with an iv bolus of either 10 mL of 23% saturated hypertonic saline, 30 mL of 7.5% hypertonic saline, or 30 mL of 7.5% saline with 6% dextran 70, each containing similar osmolar loads of 80, 80, and 100 mosM, respectively. All three solutions raised systolic blood pressure within 5 min (mean pretreatment systolic blood pressure, 87 mm Hg; mean posttreatment systolic blood pressure, 101 mm Hg; P < 0.05). The magnitude of the increase was greater with saturated hypertonic saline (15 mm Hg) and dextran 70 (17 mm Hg) compared with that with hypertonic saline (9 mm Hg; P < 0.05). At 10 min, dialysis-induced hypotension was less frequent with saturated hypertonic saline (incidence, 9%) compared with hypertonic saline (45%). Beyond 10 min, however, there was a trend toward a lower incidence of further dialysis-induced hypotension with dextran 70. There were no side effects. Given equal osmole loads, the more concentrated solution produced a greater increase in systolic blood pressure. The addition of an oncotic agent such as dextran may prolong the blood pressure response beyond 10 min. It was concluded that hypertonic saline solutions safely and effectively treat dialysis-induced hypotension.     

Effect of enteric nonnutrient infusions on motor patterns in neurally intact and neurally isolated canine jejunum

Previous work in our laboratory has shown that nonnutrient mechanical factors initiate changes in motility patterns in local and remote regions of the small intestine. Our aims were to determine how isolated duodenal and jejunoileal nonnutrient infusions alter interdigestive motor patterns locally and distantly and whether these effects are neurally mediated. Ten dogs were prepared with duodenal and proximal jejunal infusion and manometry catheters and a proximal jejunal diverting cannula. Five of these dogs served as neurally intact controls (Group 1) and five also underwent in situ neural isolation of the entire jejunoileum (Group 2: extrinsic denervation; disruption of enteric myoneural continuity with duodenum). After recovery, nonnutrient infusions at 0-15 ml/min for 5 hr into proximal duodenum or jejunum did not consistently affect cycling of the migrating motor complex (MMC). The period and duration of individual phases of the MMC and time to first phase III after the start of infusion were similar in both groups. In Group 2, duodenal characteristics (period and duration of phase II, time to first phase III) increased slightly with increasing rates of jejunal but not duodenal infusion. Motility indices, although greater in Group 2, were not altered by enteric infusions. Differing rates of nonnutrient enteric flow limited to duodenum or jejunoileum did not affect markedly local or distant motor patterns. Alterations in interdigestive motility patterns by postprandial nonnutrient intraluminal content are not mediated directly by intraluminal flow.     

Effects of infusion rates in rats receiving repeated large volumes of saline solution intravenously

The objective of this study was to investigate the longevity of positive dot enzyme immunosorbent assay (dot EIA) results for IgM and IgG to a Salmonella typhi outer membrane protein in Malaysian children with enteric fever. The patients were children one month to 12 years of age with clinical evidence of typhoid fever, positive blood or stool cultures for S. typhi, and/or a positive Widal test result who were admitted over a two-year period to General Hospital (Kota Bharu, Malaysia). These patients received standard inpatient treatment for enteric fever including chloramphenicol therapy for 14 days. Dot EIA tests were performed as part of clinical and laboratory assessments on admission, at two weeks, and then at 3, 6, 9, 12, 15, 18, and 21 months postdischarge. Assessment of the longevity of positive dot EIA IgM and IgG titers was done by Kaplan-Meier analysis. In 94 evaluable patients, 28% were dot EIA IgM positive but IgG negative on admission, 50% were both IgM and IgG positive, and 22% were IgM negative and IgG positive. Mean persistence of IgM dot EIA positivity was 2.6 months (95% confidence interval = 2.0-3.1 months) and that of IgG was 5.4 months (4.5-6.3 months). There were no significant differences between the three subgroups. Thus, positive IgM and IgG results determined by dot EIA within four and seven months, respectively, following documented or suspected enteric fever in a child from an endemic area should be interpreted with caution. In other clinical situations, the dot EIA remains a rapid and reliable aid to diagnosis.     

Use of combination prostaglandin F2alpha and hypertonic saline for midtrimester abortion

Midtrimester abortion was induced by intramniotic prostaglandin F2alpha in combination with hypertonic saline alone in 102 others. Abortion time and duration of hosptial stay were shorter with the prostaglandin-saline combination.     

Use of hypertonic (3%) saline/acetate infusion in the treatment of cerebral edema: Effect on intracranial pressure and lateral displacement of the brain

OBJECTIVE: To determine the effect of continuous hypertonic (3%) saline/acetate infusion on intracranial pressure (ICP) and lateral displacement of the brain in patients with cerebral edema. DESIGN: Retrospective chart review. SETTINGS: Neurocritical care unit of a university hospital. PATIENTS: Twenty-seven consecutive patients with cerebral edema (30 episodes), including patients with head trauma (n = 8), postoperative edema (n = 5), nontraumatic intracranial hemorrhage (n = 8), and cerebral infarction (n = 6). INTERVENTION: Intravenous infusion of 3% saline/acetate to increase serum sodium concentrations to 145 to 155 mmol/L. MEASUREMENTS AND MAIN RESULTS: A reduction in mean ICP within the first 12 hrs correlating with an increase in the serum sodium concentration was observed in patients with head trauma (r2 = .91, p = .03), and postoperative edema (r2 = .82, p = .06), but not in patients with nontraumatic intracranial hemorrhage or cerebral infarction. In patients with head trauma, the beneficial effect of hypertonic saline on ICP was short-lasting, and after 72 hrs of infusion, four patients required intravenous pentobarbital due to poor ICP control. Among the 21 patients who had a repeat computed tomographic scan within 72 hrs of initiating hypertonic saline, lateral displacement of the brain was reduced in patients with head trauma (2.8 +/- 1.4 to 1.1 +/- 0.9 [SEM]) and in patients with postoperative edema (3.1 +/- 1.6 to 1.1 +/- 0.7). This effect was not observed in patients with nontraumatic intracranial bleeding or cerebral infarction. The treatment was terminated in three patients due to the development of pulmonary edema, and was terminated in another three patients due to development of diabetes insipidus. CONCLUSIONS: Hypertonic saline administration as a 3% infusion appears to be a promising therapy for cerebral edema in patients with head trauma or postoperative edema. Further studies are required to determine the optimal duration of benefit and the specific patient population that is most likely to benefit from this treatment.     

Ontogeny of thirst in the rat: Effects of hypertonic saline, polyethylene glycol, and vena cava ligation.

Describes 3 experiments in which over 465 Sprague-Dawley rats of various ages either (a) were injected with hypertonic sodium chloride solutions to produce intracellular dehydration, (b) were injected with polyethylene glycol to induce hypovolemia, or (c) underwent ligation of the inferior vena cava to stimulate the renin-angiotensin system. 16-day-old Ss drank like adults after injection of polyethylene glycol. Hypertonic saline injection did not elicit adultlike drinking until 30 days of age, and vena cava ligation did not produce adult levels of water consumption until 42 days postnatally. It is concluded that treatments which have been associated with different mechanisms of thirst, therefore, first become effective at different times during ontogeny. (27 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Self-administered intravenous infusion of hypertonic solutions and sodium appetite of sheep.

Studied the effects of self-administered iv infusion of hypertonic NaCl, mannitol, glucose, urea, or isotonic NaCl on Na appetite. 22 Merino-Cross sheep were trained to barpress to replace Na deficits of 300–500 mmol. During basal conditions, each delivery to a drinking cup was 15 ml of .6 M NaHCO? (9 mmol). In the experimental situation, an iv infusion was given automatically with each delivery to the drinking cup. Ingestion of NaHCO? solution was significantly reduced by all hypertonic solutions, the largest decrease being caused by hypertonic NaCl or mannitol. The decreased intake was observed within 10 (with infusion of hypertonic NaCl, mannitol, or glucose) or 20–40 (with urea infusion) minutes, irrespective of whether water was concurrently available to drink. At 20 min, plasma Na was increased by hypertonic NaCl, decreased by mannitol or glucose, and not changed by urea. CSF Na concentration was increased by all hypertonic solutions. In regard to the "turn-off" of Na appetite by systemic infusion, data are consistent with the theory of neural cells within the blood–brain barrier responsive to changes of Na concentration or osmolality in their environment. In contrast, water intake was stimulated by hypertonic NaCl or mannitol but not by urea or glucose. Results suggest that the sensors involved in thirst (e.g., osmoreceptors) are in an area of the brain lacking the blood–brain barrier. (24 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Effect of increasing doses of hypertonic saline on mucociliary clearance in patients with cystic fibrosis

BACKGROUND: Patients with cystic fibrosis are known to have decreased mucociliary clearance. It has previously been shown that inhalation of a 7.0% solution of hypertonic saline significantly improved mucociliary clearance in a group of adult patients with cystic fibrosis. The aim of this study was to measure the response to increasing concentrations of inhaled hypertonic saline. METHODS: Ten patients (seven men) of mean (SE) age 22 (4) years and mean forced expiratory volume in one second (FEV1) 52.0 (6.7)% predicted completed the study. Mucociliary clearance was measured using a radioaerosol technique for 90 minutes after the interventions which comprised 0.9% NaCl + voluntary cough (control), 3.0% NaCl, 7.0% NaCl, and 12% NaCl. RESULTS: There was a significant increase in the amount of activity cleared from the right lung with all concentrations of hypertonic saline (HS) compared with control. The amount cleared at 90 minutes on the control day was 12.7% (95% confidence interval (CI) 9.8 to 17.2) compared with 19.7% (95% CI 13.6 to 29.5) for 3% HS, 23.8% (95% CI 15.9 to 36.7) for 7% HS and 26.0% (95% CI 19.8 to 35.9) for 12% HS. The improvement in mucociliary clearance was not solely due to coughing as the number of coughs recorded on the control day exceeded that recorded on any other day. The hypertonic saline did not induce a clinically significant change in FEV1. CONCLUSIONS: Within the range of concentrations examined in this study, the effect of hypertonic saline appears to be dose dependent. Inhalation of hypertonic saline remains a potentially useful treatment for patients with cystic fibrosis.     

Effect of hypertonic saline solution and dextran on ventricular blood flow and heart-lung interaction after hemorrhagic shock

BACKGROUND: Hypertonic saline solutions may have beneficial hemodynamic effects in the resuscitation of hemorrhagic shock. The effects on cardiac function and potential interaction with lung function are controversial and served as the basis for this study. METHODS: Domestic swine were resuscitated from hemorrhagic shock with equivalent sodium loads of lactated Ringer's solution (LR) or 7.5% NaCl plus 10% dextran (HSD). Hemodynamic data were obtained at baseline, shock, and after resuscitation. Right ventricular ejection fraction and left ventricular change in pressure with respect to time (dP/dt) were used to index contractility. Regional myocardial blood flow was determined with microspheres. Lung water was determined gravimetrically. RESULTS: There were no differences in the ability to restore hemodynamic parameters with equivalent sodium loads of LR and HSD resuscitation. Right ventricular ejection fraction and left ventricular change in pressure with respect to time were only transiently affected by shock and resuscitation. Regional myocardial blood flow was increased above baseline values after HSD. The total resuscitation volumes were 1958 +/- 750 mL and 140 +/- 31 mL with LR and HSD, respectively. CONCLUSIONS: Although LR and HSD were equally effective in the early resuscitation of hemorrhagic shock, this occurred at the expense of significantly greater volume requirements for resuscitation with LR. This may contribute to cardiac dysfunction in this setting. Enhanced regional myocardial blood flow after HSD resuscitation may be beneficial against ongoing myocardial stress.     

Effect of self-determined intravenous infusion of hypertonic NaCl on Na appetite of sheep.

The time delay between a rapid, systemically produced change in sodium balance and a change of voluntary sodium intake was examined in sodium-deficient sheep with a parotid fistula. They were trained to barpress to replace a daily sodium deficit of 300–500 mmol. During basal conditions on different days, each delivery to a drinking cup consisted of either a small or a large amount of NaHCO? solution. In the experimental situation, the small amount of NaHCO? was delivered to the cup, but total sodium delivered was made to equal that of the large amount by automatic concurrent infusion of hypertonic NaCl iv with each delivery to the cup. As a control, the concurrent iv infusion was .15 M NaCl, which had little influence on sodium balance. A significant difference in the cumulative number of deliveries between the hypertonic and isotonic NaCl infusion conditions occurred by 10–20 min. It is concluded that systemic injections of hypertonic NaCl are effective within 10–20 min in reducing the sodium appetite of Na-depleted animals. (19 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)