Sujets)
Humains , Mâle , Femelle , Sujet âgé , Sujet âgé de 80 ans ou plus , Spironolactone/effets indésirables , Association triméthoprime-sulfaméthoxazole/effets indésirables , Mort subite/étiologie , Antagonistes des récepteurs des minéralocorticoïdes/effets indésirables , Ontario , Spironolactone/administration et posologie , Études cas-témoins , Intervalles de confiance , Odds ratio , Association triméthoprime-sulfaméthoxazole/administration et posologie , Facteurs de risque , Facteurs âges , Interactions médicamenteuses , Association de médicaments/effets indésirables , Antagonistes des récepteurs des minéralocorticoïdes/administration et posologie , Hyperkaliémie/induit chimiquement , Hyperkaliémie/mortalité , Anti-infectieux urinaires/administration et posologie , Anti-infectieux urinaires/effets indésirablesRésumé
OBJECTIVE: This study was designed to evaluate the effects of terlipressin versus fluid resuscitation with normal saline, hypertonic saline or hypertonic-hyperoncotic hydroxyethyl starch, on hemodynamics, metabolics, blood loss and short-term survival in hemorrhagic shock. METHOD: Twenty-nine pigs were subjected to severe liver injury and treated 30 min later with either: (1) 2 mg terlipressin in a bolus, (2) placebo-treated controls, (3) 4 mL/kg 7.5% hypertonic NaCl, (4) 4 mL/kg 7.2% hypertonic-hyperoncotic hydroxyethyl starch 200/0.5, or (5) normal saline at three times lost blood volume. RESULTS: The overall mortality rate was 69%. Blood loss was significantly higher in the hypertonic-hyperoncotic hydroxyethyl starch and normal saline groups than in the terlipressin, hypertonic NaCl and placebo-treated controls groups (p<0.005). Hyperkalemia (K>5 mmol/L) before any treatment occurred in 66% of the patients (80% among non-survivors vs. 22% among survivors, p=0.019). Post-resuscitation hyperkalemia occurred in 86.66% of non-survivors vs. 0% of survivors (p<0.001). Hyperkalemia was the first sign of an unsuccessful outcome for the usual resuscitative procedure and was not related to arterial acidemia. Successfully resuscitated animals showed a significant decrease in serum potassium levels relative to the baseline value. CONCLUSION: Hyperkalemia accompanies hemorrhagic shock and, in addition to providing an early sign of the acute ischemic insult severity, may be responsible for cardiac arrest related to hemorrhagic shock.