The physiological effects of hyperosmolar resuscitation: 5% vs 3% hypertonic saline

Bellal Joseph, Hassan Aziz, Margeaux Snell, Viraj Pandit, Daniel Hays, Narong Kulvatunyou, Andrew Tang, Terence OKeeffe, Julie Wynne, Randall S. Friese, Peter Rhee

Research output: Contribution to journalArticlepeer-review

7 Scopus citations


Background Use of 5% normal saline (NS) is gaining renewed interest. The primary aim of our study was to compare the physiological effects after the administration of different concentrations of hypertonic saline (3% vs 5%NS) in the initial resuscitation of trauma.

Methods We performed a retrospective analysis of a prospectively collected database of all trauma patients who received hypertonic saline during initial resuscitation. Medical records were reviewed for serum electrolytes and serum osmolarity, coagulation parameters, complications, and mortality.

Conclusions The 5%NS has sustained higher serum osmolarity and serum sodium concentration within the first 72 hours without any increase in adverse effects in comparison with 3%NS.

Results A total of 212 patients were included in the study, of which 170 patients received 5%NS and 42 patients received 3%NS. Both groups were similar in age (41.16 ± 19 vs 44.17 + 23.6; P =.45) and ISS score (26 [17 to 29] vs 25 [16 to 27]; P =.6). Mean serum osmolarity (316 ± 20.3 vs 294 ± 22.5; P =.02) and serum sodium levels (143 ± 8.6 vs 137 ± 10.9; P <.001) remained higher in the 5%NS group within 72 hours of admission. The pH was lower in the 5%NS group compared with the 3%NS group at 24 hours (7.29 ±.12 vs 7.33 ±.12; P =.01); however, at 48 and 72 hours (7.40 ±.07 vs 7.41 ±.07; P =.7), no difference was found. There was no difference in blood products requirement (1,734 vs 2,253 mL; P =.11) between the 2 groups.

Original languageEnglish (US)
Pages (from-to)697-702
Number of pages6
JournalAmerican Journal of Surgery
Issue number5
StatePublished - Nov 1 2014
Externally publishedYes


  • 5% Normal saline
  • Complications
  • Hypertonic saline
  • Physiological effects
  • Serum sodium

ASJC Scopus subject areas

  • Surgery


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