Hypertonic Saline, Possibly with Dextran

The sodium concentration of hypertonic saline solutions is 250 to 1200 mEq/L. The theoretical advantage is that the greater the sodium concentration, the less total volume is required for adequate resuscitation. The lower infusion volume probably reflects the osmotically related movement of intracellular water into the extracellular space. Other mechanisms include a direct inotropic effect on the myocardium and a direct peripheral vasodilator effect. The main problem is severe hypernatremia, which can cause brain dehydration and can be fatal.

Various hyperosmotic-hyperoncotic solutions have been used for resuscitation of hypovolemic patients. The most common combination is hypertonic saline and 6% dextran 70. In animals, these fluids restore gut and kidney microcirculation more effectively than normal saline.^{[156] [157] [158] [159] [160] [161]} The addition of dextran increases the intravascular volume effect of hypertonic saline but does not extend the duration of effect in a clinically significant manner.^[159] Clinical practice will be required to ascertain the ultimate role, if any, of these fluids.