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Randomized, Double-Blind Trial of the Effect of Fluid Composition on Electrolyte, Acid–Base, and Fluid Homeostasis in Patients Early After Subarachnoid Hemorrhage

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Abstract

Background

Hyper- and hyponatremia are frequently observed in patients after subarachnoidal hemorrhage, and are potentially related to worse outcome. We hypothesized that the fluid regimen in these patients is associated with distinct changes in serum electrolytes, acid–base disturbances, and fluid balance.

Methods

Thirty-six consecutive patients with SAH were randomized double-blinded to either normal saline and hydroxyethyl starch dissolved in normal saline (Voluven®; saline) or balanced crystalloid and colloid solutions (Ringerfundin® and Tetraspan®; balanced, n = 18, each) for 48 h. Laboratory samples and fluid balance were evaluated at baseline and at 24 and 48 h.

Results

Age [57 ± 13 years (mean ± SD; saline) vs. 56 ± 12 years (balanced)], SAPS II (38 ± 16 vs. 34 ± 17), Hunt and Hess [3 (1–4) (median, range) vs. 2 (1–4)], and Fischer scores [3.5 (1–4) vs. 3.5 (1–4)] were similar. Serum sodium, chloride, and osmolality increased in saline only (p ≤ 0.010, time–group interaction). More patients in saline had Cl >108 mmol/L [16 (89 %) vs. 8 (44 %); p = 0.006], serum osmolality >300 mosmol/L [10 (56 %) vs. 2 (11 %); p = 0.012], a base excess <−2 [12 (67 %) vs. 2 (11 %); p = 0.001], and fluid balance >1,500 mL during the first 24 h [11 (61 %) vs. 5 (28 %); p = 0.046]. Hyponatremia and hypo-osmolality were not more frequent in the balanced group.

Conclusions

Treatment with saline-based fluids resulted in a greater number of patients with hyperchloremia, hyperosmolality, and positive fluid balance >1,500 mL early after SAH, while administration of balanced solutions did not cause more frequent hyponatremia or hypo-osmolality. These results should be confirmed in larger studies.

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Acknowledgments

We are grateful for skillful assistance by the research nurses Judith Erni-Kaufmann, Natalie Araya-Araya, Michael Lensch, Konrad Torsten, and for careful editing of the manuscript by Jeannie Wurz, medical writer. Supported by an unrestricted grant from BBraun Medical AG, Sempach, Switzerland.

Conflict of interest

The Department of Intensive Care Medicine has, or has had in the past, research contracts with Abbott Nutrition International, CSEM SA, Edwards Lifesciences Services GmbH, Kenta Biotech Ltd, Maquet Critical Care AB, Omnicare Clinical Research AG, and Orion Corporation; and research & development/consulting contracts with Edwards Lifesciences SA, Maquet Critical Care AB, and Néstle. The money is/was paid into a departmental fund; no author receives/received any personal financial gain. The department has received unrestricted educational grants from the following organizations for organizing a quarterly postgraduate educational symposium, the Berner Forum for Intensive Care: Fresenius Kabi; gsk; MSD; Lilly; Baxter; astellas; AstraZeneca; B|Braun; CSL Behring; Maquet; Novartis; Covidien; Mycomed; RobaPharma.

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Authors and Affiliations

  1. Department of Intensive Care Medicine, Bern University Hospital (Inselspital) and University of Bern, 3010, Bern, Switzerland

    Laura Lehmann, Stepani Bendel, Jukka Takala, Margaret Schafer & Stephan M. Jakob

  2. Department of Nephrology and Hypertension, Bern University Hospital (Inselspital) and University of Bern, 3010, Bern, Switzerland

    Dominik E. Uehlinger

  3. Department of Neurosurgery, Bern University Hospital (Inselspital) and University of Bern, 3010, Bern, Switzerland

    Michael Reinert

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  1. Laura Lehmann
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  2. Stepani Bendel
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Correspondence to Stephan M. Jakob.

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Registered with the Deutsches Register Klinischer Studien, trial number DRKS000034.

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Lehmann, L., Bendel, S., Uehlinger, D.E. et al. Randomized, Double-Blind Trial of the Effect of Fluid Composition on Electrolyte, Acid–Base, and Fluid Homeostasis in Patients Early After Subarachnoid Hemorrhage. Neurocrit Care 18, 5–12 (2013). https://doi.org/10.1007/s12028-012-9764-3

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