The reduction of
burn edema is a common goal in the
resuscitation of patients with thermal injury. Initial infusion of a 2400 mOsm hypertonic 7.5% NaCl 6%
dextran (HSD) has been shown to reduce volume needs, but elevated serum
sodium levels limit the dose that can be safely used. This study tested the hypothesis that a 2400 mOsm
solution of NaCl,
amino acids,
glucose, and 6%
dextran (
Isosal-D) would reduce similar volume requirements while maintaining normal plasma
sodium levels. Hemodynamics, plasma
sodium, fluid balance, and tissue water content were measured after an initial baseline period and during
resuscitation of a large scald injury in 21 anesthetized sheep.
Resuscitation was begun 30 minutes after the scald with infusion of 10 ml/kg of either
lactated Ringer's (LR),
Isosal-D, or HSD and was continued with LR to restore and maintain baseline
oxygen delivery throughout the 8-hour period.
Oxygen delivery, cardiac output, and mean arterial pressure were rapidly reestablished by all three solutions, although a persistent
tachycardia was noted with
Isosal-D. Net fluid requirements of both HSD (35 +/- 13 ml/kg) and
Isosal-D (72 +/- 13 ml/kg) were significantly lower than in the LR group (203 +/- 39 ml/kg). Mean serum
sodium increased 11 mEq with HSD to a peak after 4 hours of 152 +/- 5 mEq, whereas with LR
sodium fell 7 mEq to 132 +/- 4.
Isosal-treated animals had minimal change in serum
sodium. HSD significantly decreased tissue water content in colon, liver, pancreas, and nonburned skin compared with LR, whereas
Isosal-D reduced
edema only in the colon. It is concluded that in this protocol
Isosal-D was not as effective as HSD at reducing volume needs and
edema and had unexpected chronotropic effects.