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Abstract: SA-PO481

A Salty Goodbye to Cardiorenal and Hepatorenal Syndromes: Hypertonic Saline Diuresis

Session Information

Category: Fluid‚ Electrolyte‚ and Acid-Base Disorders

  • 1002 Fluid‚ Electrolyte‚ and Acid-Base Disorders: Clinical

Author

  • Barnett, Sean, United States Air Force, San Antonio, Texas, United States
Introduction

Diuresis and anti-diuresis are the most pivotal aspects of the cardiovascular system. The pathology of Cardiorenal Syndrome (CRS) and Hepatorenal Syndrome (HRS) are due in large part to a lack of diuresis. The lack of diuresis is due to the Renin Angiotensin Aldosterone System (RAAS) and Antidiuretic Hormone (ADH). The cardiac output, renal perfusion pressure, and neurohormonal controls of diuresis can be accentuated physiologically with 3% Saline to aid in treating this pathophysiology.

Case Description

30 patients with CRS, HRS, CHF or ARDS were treated using 100mL of 3% Saline. 28 patients (93%) responded appropriately and only 2 patients (7%) had no response. Of the responders, 25 (89%) demonstrated a significant change in clinical course within 24 hours. No patient experienced any complications associated with this treatment. No patient experienced hypernatremia.

Discussion

Hypertonic Saline, specifically 3% Saline, is the best diuretic adjunct we have in medicine. It is well studied in heart failure and many diverse settings, 3% Saline is a safe and effective way to ensure adequate diuresis while protecting both the heart and the kidneys. In the setting of CRS or HRS, 3% Saline can function as a better adjunct for diuresis and as a diagnostic test in most settings.
Physiologically, CRS and HRS arise primarily from poor renal perfusion and excessive activation of RAAS and ADH, with decreased activation or response to ANP and BNP. The urinary evaluation will generally demonstrate a low sodium, high potassium, and high osmolarity. Combining physiology with evidence-based medicine, the goal would be a higher urine sodium (>50meq/L), a high urinary sodium to potassium ratio, and a low urine osmolarity.

This exact situation is achieved by 3% Saline. 3% Saline functions to improve preload, stimulate ANP in the Right Atrium, decrease pulmonary vascular resistance, improve cardiac output, inhibit RAAS (directly and indirectly) and inhibit ADH (directly and indirectly). 3% Saline can be used as a safe and effective treatment for most diuresis.

Fortunately, the overall concentration of 3% appears to be the perfect balance of effect without complications. 3% can be given through a peripheral IV at rates under 50mL/hr, 3% can be given outside the ICU, and small amounts of 3% have almost no significant complications in all medical literature.