© Science and Education Publishing DOI:10.12691/ajeid-3-4-1 Impact of Hyperosmolar Sodium-Lactate Resuscitation on Lactate Clearance in Pediatric Severe Sepsis

Abstract Background: Fluid resuscitation with normal saline (NS) could aggravate lactate production. Our objective was to compare the impact the of small volume resuscitation using hyperosmolar sodium-lactate (HSL) versus NS in pediatric severe sepsis. The primary endpoint was the increased of lactate clearance after 1 and 6 hours of fluid resuscitation. The secondary endpoint was the incidence of fluid overload and serum sodium level. Methodology and principal findings: A clinical trial study on 34 severe sepsis children was conducted in Hasan Sadikin Hospital Bandung, Indonesia. Eligible subjects were newly diagnosed severe sepsis children (1−14 years old). Patients were resuscitated with either HSL (bolus of 5 mL/kgBW, repeated if no response and followed by 1 mL/kgBW/hour for 12 hours), or NS (bolus of 20 mL/kgBW, repeated if no response and followed by maintenance fluid requirement). If shock persisted, inotropes and/or catecholamine were commenced. HSL group had significant higher 1 hour and 6 hours lactate clearance compared to NS group (p<0.05 and <0.01 respectively). HSL group had significant lower incidence of fluid overload compared to NS group (p<0.001). HSL and NS group had no significant difference serum sodium level after fluid resuscitation (p=0.601). Conclusions: There was an impact of HSL on lactate clearance after 1 and 6 hours fluid resuscitation. As lower fluid overload incidence was observed in HSL group, HSL solution might likely to be a promising fluid for small volume resuscitation in severe sepsi