J Vet Intern Med 2011;25:1138–1143

A Comparison of Hypertonic (7.2%) and Isotonic (0.9%)

Saline for Fluid Resuscitation in Horses: A Randomized,
Double-blinded, Clinical Trial
C.L. Fielding and K.G. Magdesian
Background: Hypertonic saline solution (7.2%) (HSS) can quickly replace intravascular volume deficits. HSS more
recently has been advocated in the treatment of traumatic brain injury, but its use in dehydrated patients remains contro-
versial.
Hypothesis: Hypertonic saline solution will show a significant improvement in both clinical and laboratory hydration
parameters as compared to isotonic (0.9%) saline solution (ISS).
Animals: Endurance horses eliminated from the 2009 Western States 100-mile (220-km) endurance ride and requiring
IV fluid therapy were eligible for enrollment in the study.
Methods: Twenty-two horses were randomly assigned to receive 4 mL/kg of either HSS or ISS along with 5 L lactated
Ringer’s solution (LRS). After this bolus, horses were treated with additional LRS in varying amounts. Blood and urine sam-
ples were collected before, during, and after treatment. Data were compared using 2-way ANOVA with repeated measures.
Results: As compared to ISS, HSS horses showed greater decreases in PCV (P = .04), total protein (P = .01), albumin
(P = .01), and globulin (P = .02) concentrations. HSS horses showed greater increases in sodium and chloride (P < .001)
as compared to ISS horses. Horses receiving HSS had a shorter time to urination (P = .03) and lower specific gravity
(P < .001) than those receiving ISS.
Conclusions: Results of this study indicate that HSS may provide faster restoration of intravascular volume deficits
than ISS in endurance horses receiving emergency medical treatment. More marked electrolyte changes should be expected
with HSS, however, and additional fluids after HSS administration likely are needed.
Key words: Endurance; Fluid therapy; Resuscitation; Tonicity.

he use of hypertonic saline solution (HSS) has

T been described for the treatment of intravascular
volume deficits in a variety of species secondary to
controlled hemorrhage, sepsis, and other emergency
conditions associated with hypovolemia.1–6 The initial
proposed mechanism responsible for its beneficial
effects was its osmotic attraction of fluid from the
intracellular space.1,7–8 More recent research indicates
that other benefits may include the indirect release of
vasopressin and activation of aquaporin channels,
immunomodulatory effects, and alterations of the
vascular endothelium.9–11 In the clinical setting, HSS is
now recommended for the treatment of traumatic
brain injury.12
There have been primarily experimental studies in
horses evaluating the effects of HSS in a variety of clini-
cal models including endotoxemia and controlled hem-
orrhage.13–17 A recent clinical trial examined the effects
of HSS before anesthesia for abdominal surgery.18 The
results of this study showed greater cardiovascular bene-
fit with a colloid solution than with HSS. Additional
From the Loomis Basin Equine Medical Center, Loomis, CA
(Fielding) and the Departments of Medicine and Epidemiology,
School of Veterinary Medicine, University of California, Davis,
CA (Magdesian). This study was performed at the 2009 Western
States 100-mile endurance ride in Auburn, CA. A portion of this
study was presented at the 2011 ACVIM Forum.
Corresponding author: C. Langdon Fielding, Loomis Basin
Equine Medical Center, P.O. Box 2059, Loomis, CA 95650;
e-mail: langdonfielding@yahoo.com.
Submitted February 4, 2011; Revised May 11, 2011;
Accepted July 18, 2011.
Copyright © 2011 by the American College of Veterinary Internal
Medicine
10.1111/j.1939-1676.2011.00789.x
Abbreviations:
ECFV extracellular fluid volume
HSS hypertonic saline solution
ICFV intracellular fluid volume
ISS isotonic saline solution
clinical trials are needed to determine if there is a place
for HSS in the emergency treatment of horses.
Controversy exists about the use of HSS in horses
with dehydration.19,20 The concern is that these
animals may have clinically relevant intracellular fluid
deficits and therefore should not be treated with a
hyperosmotic agent.19 Endurance horses requiring
emergency treatment represent a group of dehydrated
patients requiring fluid resuscitation.21 HSS could be
an ideal fluid for this patient population if it is able to
rapidly expand the vascular volume as it has done in
other equine studies.
The purpose of this study was to compare the effects
of a 7.2% HSS solution with those of a 0.9% saline
solution (ISS) in a randomized, double-blinded clinical
trial. The study groups consisted of horses eliminated
from endurance competition because of signs of dehy-
dration and hypovolemia, as well as metabolic failure
requiring emergency medical treatment. We tested the
hypothesis that HSS would more rapidly improve
clinical and biochemical variables associated with
intravascular volume expansion than would ISS.
Materials and Methods
The study took place at the 2009 Western States 100-mile
(220-km) endurance ride (Tevis Cup). The study was approved
 Hypertonic Saline in Horses 1139

by the Clinical Trials Review Board of the William R. Pritchard, istry analyzer (Na+, K+, Cl , and ionized Ca++).i Simplified
Veterinary Medical Teaching Hospital University of California, strong ion difference (SSID) was calculated as: [sodium] – [chlo-
Davis and client consent was obtained. ride].
Horses were treated at the 40, 58, 111, or 160-km mark on the
racecourse depending on the location where they were eliminated.
All horses designated as disqualified for “metabolic” reasons by a
Statistical Analysis
ride veterinarian were eligible for entry into the study. These met- Data are reported as mean (± SD). Data were assessed for
abolic conditions included acute abdominal disease (colic), exer- normality using the Kolmogorov and Smirnov method. Admis-
tional myopathy, and poor cardiovascular recovery, and have sion and posttreatment data were analyzed using an unpaired t-
been previously described in endurance horses.21 Horses were test or Mann–Whitney test depending on whether they were
excluded from the study if they had been treated with IV fluids normally distributed or not, respectively. Fisher’s exact test with
before admission to the treatment center. The owner of 1 eligible calculation of odds ratios was used to evaluate for differences in
horse declined enrollment in the study. categorical variables in baseline data between the 2 groups. Clini-
cal and clinicopathological data between treatment groups were
Study Design
All personnel were blinded to the treatment group until after Table 1. Baseline characteristics of horses receiving
the study was completed. After admission to the treatment hypertonic (7.2%) and isotonic (0.9%) saline solution
center, each horse had a routine physical examination per- (HSS and ISS) (mean ± SD).
formed. Rectal temperature, heart rate, respiratory rate, mucous
membrane color, and capillary refill time were recorded. Blood Variable ISS HSS P-values
samples were collected from the jugular vein and were placed
Sample size 11 11 N/A
into evacuated tubes containing potassium EDTA and sodium
Age (years) 11.3 ± 2.5 13 ± 3.9 .23
heparin. One of the tubes containing sodium heparin was centri-
8 Arabians
fuged and the plasma collected and transferred to storage at
1 Half-
70°C within 12 hours.
Arabian
A 14 gauge IV cathetera was placed in a jugular vein and flu-
1 Rocky
ids were administered by gravity flow through an IV infusion
7 Arabians Mountain
set.b Each horse was assigned a treatment code with a corre-
Breed 4 Half-Arabians 1 Unknown .48
sponding IV fluid that was blinded to the personnel administer-
8 Geldings
ing the fluid and to the treatment veterinarians. A treatment
2 Mares 5 Geldings
letter was assigned to 1 of the 2 fluid types before the start of the
Gender 1 Stallion 6 Mares .18
study according to a code produced by a random number genera-
3 Synchronous
tor. Numbers were assigned according to a block randomization
diaphragmatic
design. Horses in the HSS group received an initial bolus of 2 L
flutter 3 Synchronous
of 7.2% salinecand 5 L of lactated Ringer’s solution (LRS)d
3 Failure to diaphragmatic
simultaneously followed by additional LRS as deemed necessary
recover flutter
by the treating veterinarian. Horses in the ISS group received an
2 Colic 5 Failure to
initial bolus of 2 L of 0.9% salinee and 5 L of LRS followed by
3 recover
additional LRS as deemed necessary by the treating veterinarian.
Diagnosis Rhabdomyolysis 3 Colic
The initial 5 L of LRS given to all horses also contained 250 mL
Heart rate
of 23% calcium gluconate solution.f
(bpm) 63 ± 10 64 ± 18 .93
After the initial 7 L bolus of fluids (HSS or ISS + 5 L LRS),
Temperature
physical examinations were repeated and blood samples were col-
(°F) 99.7 ± 1.3 100.4 ± 1.1 .25
lected. The study was terminated when the treating veterinarians
PCV (%) 49 ± 7 46 ± 7 .31
determined that the horses no longer required IV fluid administra-
TPP (g/dL) 8.4 ± 1.1 8.5 ± 0.6 .68
tion. This determination was based on the clinical examination
Lactate
findings and serum biochemical results available. Urine samples
(mmol/L) 2.3 ± 0.8 2.4 ± 0.9 .79
were collected by voiding when horses were observed to urinate.
Na (mEq/L) 135 ± 6 137 ± 3 .99
Urine volume and specific gravity were recorded upon collection.
K (mEq/L) 3.3 ± 0.4 3.4 ± 0.7 .565
Specific gravity was estimated using refractometry. A sample of
Cl (mEq/L) 97 ± 7 99 ± 4 .965
the urine was centrifuged and transferred to storage at 70°C
Ca++ (mmol/L) 1.2 ± 0.3 1.3 ± 0.1 .532
within 12 hours. Horses were allowed free access to water during
SSID (mEq/L) 39 ± 3 38 ± 3 .629
the study, but the amount of oral fluids consumed could not be
TCO2 (mEq/L) 27.1 ± 1.8 27.5 ± 2.5 .64
recorded. Some horses with colic initially were restricted from feed
CK (IU/L) 5716 ± 6271 3528 ± 4103 .72
but all other horses had free access to grass hay and alfalfa hay.
AST (IU/L) 791 ± 622 590 ± 378 .49
BUN (mg/dL) 35 ± 16 31 ± 5 .45
Sample Analysis Creatinine
(mg/dL) 1.6 ± 0.4 1.6 ± 0.4 .92
Biochemistry profiles were analyzed on plasma within T Bil (mg/dL) 3.2 ± 1.2 3.1 ± 0.8 .89
12 hours using a commercial chemistry analyzer.g PCV was GGT (IU/L) 20.6 ± 10.2 22.7 ± 5.6 .09
determined using the micro-hematocrit method. Plasma total pro- Albumin (g/
tein (TP) concentration was measured using refractometery. dL) 3.4 ± 0.4 3.5 ± 0.4 .67
Whole blood lactate was measured using a commercial lactate Globulin (g/
analyzer immediately upon collection.h Frozen plasma and urine dL) 4.5 ± 0.7 4.6 ± 0.5 .81
samples were analyzed for electrolytes using a commercial chem-
1140 Fielding and Magdesian

compared over time using 2-way ANOVA with repeated meas-
ures. A significance level of P < .05 was used.
Results
The baseline data from the 2 groups, including clini-
cal diagnoses, are shown in Table 1 and there were no
statistically significant differences. Group sizes were
equal with 11 horses in each. The horses in the ISS
group received 21.5 ± 5.2 L of fluids during the
study whereas the HSS group received 17.9 ± 3.0 L
(P = .14). All horses enrolled in the study recovered
completely with treatment and none of the horses
required referral to an equine hospital or euthanasia.
Comparisons after treatment are shown in Table 2 and
are separated after receiving 7 L of fluids (2 L of study
fluid + 5 L LRS) and then a total of 17 L of fluids (ie,
additional 10 L of LRS). There were no significant dif-
ferences in mucous membrane color or capillary refill
time between the 2 groups.
Two-way ANOVA with repeated measures revealed
statistically significant time-treatment interactions with
decreases in PCV (P = .04), TP (P = .01), globulin
(P = .02), and albumin (P = .02) concentrations in the
HSS group as compared to the ISS group after the ini-
tial bolus. The plasma sodium and chloride concentra-
tions showed statistically significant time-treatment
interactions and main treatment effect, with statisti-
cally significant increases in sodium and chloride in the
HSS group (P < .001 after the initial bolus, and
P < .01 after the 17 L fluid administration (2 L HS or
ISS + 10 L LRS).
Electrolyte results from urine samples are shown in
Table 3. No significant abnormalities were detected
between the groups in urine electrolyte concentrations.
The time to first urination was shorter for horses in
the HSS group (69 ± 36 minutes) than for horses in
the ISS group (128 ± 66 minutes) and was statistically
significant (P = .03). The specific gravity from the first
urination sample in the ISS group was 1.046 ± .007,
which was significantly higher than the specific gravity
of 1.026 ± .012 observed in the first urination of the
HSS group (P = .0007).
Discussion
The greater decrease in both PCV and TP observed
in the HSS group as compared to the ISS group in this
clinical trial is consistent with previous experimental
studies.17 This observation supports a greater expan-
sion of plasma volume by HSS than ISS. Changes in
hemoglobin concentration have been used to estimate
changes in plasma volume and appear to be inversely
related, although this relationship may be less reliable
in horses.22,23 The change in TPP has been used as an
assessment of the change in the size of the plasma vol-
ume assuming no change in the overall amount of pro-
tein.24–26 Based on this assumption, the plasma volume
may have expanded as much as 29.1 ± 4.0% in the
HSS group. A similar calculation for the ISS group
revealed a change of only 12.0 ± 14.6% which was
significantly smaller (P < .0001). Treatment with HSS
may increase the plasma volume more than twice as
much as ISS.

Table 2. Posttreatment characteristics of the horses receiving hypertonic (7.2%) and isotonic (0.9%) saline (HSS
and ISS).
Post-7 L of Fluids Post-17 L of Fluids

Variable ISS HSS P-value ISS HSS P-value

Heart rate (bpm) 46 ± 6 45 ± 9 .88 48 ± 11 47 ± 5 .32
Temperature (°F) 98.9 ± 1.7 100.1 ± 0.5 .10 98.5 ± 1.6 99.8 ± 0.7 .09
PCV (%)* 40 ± 8 33 ± 4 .015 37 ± 6 34 ± 7 .118
TP (g/dL)* 7.2 ± 0.6 6.2 ± 0.3 .0007 6.4 ± 0.4 6.3 ± 0.5 .507
Lactate (mmol/L) 2.0 ± 0.8 1.8 ± 0.8 .646 2.1 ± 0.7 1.6 ± 0.7 .089
Na (mEq/L)* 136 ± 4 143 ± 3 .0012 135 ± 3 139 ± 3 .0086
K (mEq/L) 2.8 ± 0.6 3.1 ± 0.4 .285 3.1 ± 0.4 3.3 ± 0.2 .274
Cl (mEq/L)* 99 ± 4 108 ± 6 .0027 102 ± 3 106 ± 4 .0208
SSID (mEq/L) 38 ± 5 35 ± 5 .270 33 ± 2 33 ± 2 .426
Ca++ (mmol/L) 1.6 ± 0.2 1.6 ± 0.2 .692 1.3 ± 0.1 1.3 ± 0.1 .944
TCO2 (mEq/L) 26.8 ± 2.5 24.9 ± 2.0 .07 25.5 ± 2.2 24.5 ± 4.0 .99
CK (IU/L) 5487 ± 6711 2789 ± 4391 .762 5233 ± 6776 2588 ± 4411 .762
AST (IU/L) 859 ± 743 422 ± 263 .115 713 ± 604 432 ± 282 .181
BUN (mg/dL) 34 ± 13 28 ± 4 .194 34 ± 12 26 ± 4 .067
Creatinine (mg/dL) 1.4 ± 0.3 1.3 ± 0.3 .462 1.4 ± 0.4 1.2 ± 0.3 .133
T Bil (mg/dL) 2.7 ± 1.1 2.3 ± 0.6 .293 2.7 ± 1.0 2.2 ± 0.6 .268
GGT (IU/L) 16 ± 7 16 ± 5 .751 16 ± 7 17 ± 8 .916
Albumin (g/dL)* 2.9 ± 0.3 2.5 ± 0.2 .0065 2.8 ± 0.5 2.6 ± 0.2 .777
Globulin (g/dL)* 3.9 ± 0.5 3.3 ± 0.2 .02 3.7 ± 0.5 3.4 ± 0.3 .14

*Denotes values that are statistically different (P-value listed in table).

Comparisons between fluid types are made at two time points during treatment: (1) after 7 L of administered IV fluids in the first set
of three columns and (2) after 17 L of administered IV fluids in the second set of three columns.
 Hypertonic Saline in Horses
Table 3. Urine electrolyte values comparing horses
receiving hypertonic saline (9.2%) solution and iso-
tonic (0.9%) saline solution (HSS and ISS).
Urine electrolyte HSS ISS
Na (mEq/L) 99 ± 37 62 ± 54
K (mEq/L) 50 ± 52 60 ± 44
Cl (mEq/L) 148 ± 57 210 ± 122
Ca++ (mmol/L) 3.5 ± 2.5 2.9 ± 1.6
SSID (mEq/L) −49 ± 56 −137 ± 173
Urine samples are from the first urination after the start of
treatment.
There are 2 likely mechanisms for this larger expan-
sion. First, the HSS administration may have osmoti-
cally drawn fluid from the interstitial space,
intracellular fluid space or both into the vascular
space.1,7 This would result in dilution of the PCV and
TP as observed. The other possibility is that the
increase in plasma sodium concentration created by
the HSS induced a greater thirst response.27 These
horses may have consumed more water during the ini-
tial period which would have allowed a more rapid
expansion of the vascular volume. From a clinical
standpoint, both mechanisms likely contributed to the
observed results and either would result in a larger
expansion of the plasma volume which is likely to be
beneficial in dehydrated and hypovolemic endurance
horses.
Estimations of changes in the extracellular fluid vol-
ume (ECFV) in the horses of this study suggest a
greater increase with the administration of HSS. The
previously described sodium dilution principle can be
used to give an estimated range of the change in
ECFV that may have occurred in these horses.28
Assuming an ECFV of between 80 and 120 L before
treatment, horses in the HSS group would have experi-
enced an estimated expansion of between 15.9 and
17.9 L using previous studies for approximate weights
of endurance horses and approximate size of the
equine ECFV.29,30 Conversely, horses in the ISS group
would have an estimated expansion of only 7.5–7.7 L
which is approximately the amount of fluid adminis-
tered. A comparison anywhere in the physiologic range
of ECFV would yield a highly significant difference
between expansion with HSS and ISS (P < .0001).
These data support an estimated increase in ECFV of
approximately 8–10 L beyond the volume of fluid
administered IV. These are similar to the results
observed when TP is used to estimate changes in
plasma volume. Calculations using the sodium dilution
principle are subject to a number of limitations and
assumptions as have been previously discussed.28 A
more rigorous study using an exogenously administered
dilution indicator would be needed to confirm these
estimated results. However, if the expansion of the
ECFV was a result of contraction of the ICFV, replace-
ment of this loss is likely warranted with additional IV
or PO fluids.
The HSS group had a shorter time to urination;
increases in urinary frequency have been previously
1141
observed with HSS in horses.17 The present study
also indicated significantly more dilute urine after
HSS administration. These observations also are
consistent with a more rapid increase in the plasma
P-value volume. The increased sodium load likely also con-
.130 tributed to diuresis.7 Faster onset to urine production
.678 could indicate improved renal perfusion. This could
.227 be of potential benefit in this group of horses, as it
.581 might provide some degree of protection from renal
.198
failure associated with dehydration, rhabdomyolysis,
or both.31
The present study did not specifically evaluate the
need for additional fluids after HSS administration.
However, the clinical experience of the authors sug-
gests that it is extremely important that HSS adminis-
tration is followed by either isotonic or hypotonic IV
or PO fluids. This same recommendation has been
made by other authors.32,33
The groups appear to have been randomized well
based on the analysis of the admission variables stud-
ied. However, one important limitation was the
uneven distribution of horses with exertional rhabd-
omyolysis. All 3 of the horses with this condition
were randomized to the ISS group. In a previous
study, these horses did not have significantly different
clinical signs and electrolyte changes as compared to
other endurance horses with different conditions.21
Some authors have recommended alkalinization of
urine in human patients with rhabdomyolysis and
associated renal failure.31 In a previous study in
horses, the administration of sodium chloride-rich flu-
ids produced a metabolic acidosis but did not evalu-
ate urinary changes in electrolytes attributable to
HSS administration.14 The present study did not eval-
uate the effects of HSS on acid-base status or the
appropriateness of fluids in horses with exertional
rhabdomyolysis specifically.
One of the major limitations of this study was
sample size. However, we were limited by the number
of endurance horses requiring emergency treatment.
A study that was performed at multiple endurance
competitions (ie, larger study population) would have
improved the statistical power and allowed these
results to be applied to a larger population.
An additional limitation of the study was our inabil-
ity to quantify the amount of water consumed and
urine produced by each horse. Horses entered into the
study were treated in a race setting where multiple
water sources were available. Many of the horses
would only drink out of larger water troughs and we
did not believe that it was ethically appropriate to
restrict water intake for the purposes of the study. In
addition, a urinary collection system could not be
placed on these client-owned horses and therefore total
urine output could not be easily quantified.
Based on the results of this study, the administration
of approximately 4 mL/kg of 7.2% HSS appears to be
safe in the treatment of horses disqualified for dehy-
dration, metabolic problems or both encountered in
endurance horses. When the fluid is followed by the
administration of LRS, it appears to expand plasma
1142 Fielding and Magdesian

volume, and ECFV to a greater degree than 0.9% 13. Bertone JJ, Shoemaker KE. Effect of hypertonic and iso-
saline solution. tonic saline solutions on plasma constituents of conscious horses.
Am J Vet Res 1992; 53(10):1844–9.
14. Schmall LM, Muir WW, Robertson JT. Haematological,
serum electrolyte and blood gas effects of small volume hyper-
tonic saline in experimentally induced haemorrhagic shock.
Footnotes Equine Vet J 1990; 22(4):278–83.
a 15. Pantaleon LG, Furr MO, McKenzie HC, et al. Effects of
BD Angiocath, BD, Sandy, UT
b small- and large-volume resuscitation on coagulation and electro-
IV 1000 STAT, International WIN, Kennett Square, PA
c lytes during experimental endotoxemia in anesthetized horses.
Hypertonic saline 7.2%; VETone, Meridian, ID
d J Vet Intern Med 2007; 21(6):1374–9.
Lactated Ringer’s; Baxter, Deerfield, IL
e 16. Bertone JJ, Gossett KA, Shoemaker KE, et al. Effect of
0.9% sodium chloride, Baxter
f hypertonic vs isotonic saline solution on responses to sublethal
23% Calcium gluconate; VEDCO, St. Joseph, MO
g Escherichia coli endotoxemia in horses. Am J Vet Res 1990; 51
Vet Scan VS2; Abaxis, Union City, CA
h (7):999–1007.
Accutrend Lactate Analyzer; Roche Diagnostics, Indianapolis,
17. Gasthuys F, Messeman C, De Moor A. Influence of
IN
i hypertonic saline solution 7.2% on different hematological
ABL 805, Radiometer Medical ApS, Bronshoj, Denmark
parameters in awake and anaesthetized ponies. Zentralbl Veterin-
armed A 1992; 39(3):204–14.
18. Hallowell GD, Corley KT. Preoperative administration
of hydroxyethyl starch or hypertonic saline to horses with colic.
Acknowledgments J Vet Intern Med 2006; 20(4):980–6.
19. Divers TJ. Shock and temperature-related problems. In:
This study was supported in part by the Western Orsini JA, Divers TJ, eds. Equine Emergencies, 3rd ed. St. Louis,
States Trail Foundation and by Abaxis. MO: Saunders Elsevier, 2008: 553–557.
20. Whiting J. The exhausted horse. In: Robinson NE, Spray-
References berry KA, eds. Current Therapy in Equine Medicine, 6th ed. St
Louis, MO: Saunders Elsevier; 2009: 926–929.
1. Puyana JC. Resuscitation of hypovolemic shock. In: Fink 21. Fielding CL, Magdesian KG, Rhodes DM, et al. Clinical
MP, Abraham E, Vincent JL, et al., eds. Textbook of Critical and biochemical abnormalities in endurance horses eliminated
Care. Philadelphia, PA: Elsevier Saunders; 2005: 1933–1943. from competition for medical complications and requiring emer-
2. Magdesian KG. Critical care and fluid therapy for horses. gency medical treatment: 30 cases (2005-2006). J Vet Emerg Crit
In: Smith BP, ed. Large Animal Internal Medicine. St. Louis, Care 2009; 19(5):473–8.
MO: Mosby Elsevier; 2009: 1487–1505. 22. Drobin D, Hahn RG. Kinetics of isotonic and hyper-
3. Corley KT. Fluid therapy for horses with gastrointestinal tonic plasma volume expanders. Anesthesiology 2002; 96(6):
diseases. In: Smith BP, ed. Large Animal Internal Medicine. St 1371–80.
Louis, MO: Mosby Elsevier; 2009: 767–779. 23. Brauer LP, Svensen CH, Hahn RG, et al. Influence of rate
4. Hardy J. Critical care. In Reed SM, Bayly WM, Sellon and volume of infusion on the kinetics of 0.9% saline and 7.5%
DC, eds. Equine Internal Medicine. St. Louis, MO: Saunders; saline/6.0% Dextran 70 in sheep. Anesth Analg 2002; 95:1547–
2004: 273–288. 56.
5. Hannemann L, Reinhart K, Korell R, et al. Hyper- 24. Rumbaugh GE, Carlson GP, Harrold D. Clinicopatho-
tonic saline in stabilized hyperdynamic sepsis. Shock 1996; 5 logic effects of rapid infusion of 5% sodium bicarbonate in
(2):130–4. 5% dextrose in the horse. J Am Vet Med Assoc 1981; 178:
6. Coimbra R, Hoyt DB, Junger WG, et al. Hypertonic saline 267–271.
resuscitation decreases susceptibility to sepsis after hemorrhagic 25. Gilligan DR, Altschule MD, Volk MC. The effects on the
shock. Shock 1996; 5(2):130–4. cardiovascular system of fluids administered intravenously in
7. Svensen CH, Waldrop KS, Edsberg L, et al. Natriuresis man. I. Studies of the amount and duration of changes in blood
and the extracellular volume expansion by hypertonic saline. volume. J Clin Invest 1938; 17:7–16.
J Surg Res 2003; 113:6–12. 26. Ludders JW, Palos HM, Erb HN, et al. Plasma arginine
8. Kramer GC. Hypertonic resuscitation: Physiologic mecha- vasopressin concentration in horses undergoing colic surgery.
nisms and recommendations for trauma care. J Trauma 2003;54 J Vet Emerg Crit Care 2009; 19(6):528–535.
(5 Suppl):S89–99. 27. McAloon Dyke M, Davis KM, Clark BA, et al. Effects of
9. Batista MB, Bravin AC, Lopes LM, et al. Pressor response hypertonicity on water intake in the elderly: an age-related fail-
to fluid resuscitation in endotoxic shock: Involvement of vaso- ure. Geriatr Nephrol Urol 1997; 7(1):11–6.
pressin. Crit Care Med 2009; 37(11):2968–72. 28. Fielding CL, Magdesian KG, Carlson GP, et al. Applica-
10. Radhakrishnan RS, Shah SK, Lance SH, et al. Hypertonic tion of the sodium dilution principle to calculate extracellular
saline alters hydraulic conductivity and up-regulates mucosal/sub- fluid volume changes in horses during dehydration and rehydra-
mucosal aquaporin 4 in resuscitation-induced intestinal edema. tion. Am J Vet Res 2008; 69(11):1506–11.
Crit Care Med 2009; 37(11):2946–52. 29. Barton MH, Williamson L, Jacks S, et al. Body weight,
11. Pascual JL, Khwaja KA, Ferri LE, et al. Hypertonic sal- hematologic findings, and serum and plasma biochemical findings
ine resuscitation attenuates neutrophil lung sequestration and of horses competing in a 48-, 83-, or 159-km endurance ride
transmigration by diminishing leukocyte-endothelial interactions under similar terrain and weather conditions. Am J Vet Res
in a two-hit model of hemorrhagic shock and infection. J Trauma 2003; 64(6):746–53.
2003;54(1):121–30; discussion 130-2. 30. Fielding CL, Magdesian KG, Elliott DA, et al. Pharmaco-
12. Banks CJ, Furyk JS. Review article: Hypertonic saline use kinetics and clinical utility of sodium bromide (NaBr) as an esti-
in the emergency department. Emerg Med Australas 2008; 20 mator of extracellular fluid volume in horses. J Vet Intern Med
(4):294–305. 2003; 17(2):213–7.
 Hypertonic Saline in Horses 1143

31. Holt SG, Moore KP. Pathogenesis and treatment of renal
dysfunction in rhabdomyolysis. Intensive Care Med 2001;
27:803–811.
32. Dallap Schaer B, Orsini JA. Gastrointestinal system. In:
Orsini JA, Divers TJ, eds. Equine Emergencies, 3rd edition. St.
Louis, MO: Saunders Elsevier, 2008: 101–188.
33. Fielding CL, Magdesian KG. Review of the use of hyper-
tonic saline in equine practice. Proceedings of the 56th Annual
Convention of the American Association of Equine Practitioners,
Baltimore, MD, December 4–8, 2010.