Anest. intenziv. Med. 2025;36(4):253-261 | DOI: 10.36290/aim.2025.047

Hypertonic sodium lactate solution in the resuscitation of septic shock: a narrative review of pathophysiology, preclinical and clinical dataReview Article

Kříž M.¹, Nalos M.^{1, 2}, Vintrych P.^{3, 4}, Müller J.^{1, 4}, Raděj J.^{1, 4}, Matějovič M.^{1, 4}

¹ Jednotka intenzivní péče, I. interní klinika, Lékařská fakulta v Plzni, Univerzita Karlova a Fakultní nemocnice Plzeň

² Klinika anesteziologie, resuscitace a intenzivní medicíny, Lékařská fakulta v Plzni, Univerzita Karlova

³ Kardiologická klinika, Lékařská fakulta v Plzni, Univerzita Karlova a Fakultní nemocnice Plzeň

⁴ Biomedicínské centrum, Lékařská fakulta v Plzni, Univerzita Karlova

Aim: Excessive fluid accumulation during fluid resuscitation is associated with increased mortality and organ dysfunction. The promise of personalized fluid therapy lies in maximizing its benefits while minimizing the harmful effects of fluid resuscitation. This includes prediction of the hemodynamic response to infusion and careful consideration of its volume and composition in the context of the clinical situation. In light of recent paradigm shifts in lactate metabolism, we therefore discuss current evidence on the concept of low-volume intravenous resuscitation with hypertonic sodium lactate (HSL).

Design: A narrative review of the current literature on basic, applied and clinical research relevant to the issue of fluid resuscitation with hypertonic solution.

Method: Keyword search of PubMed and Google Scholar databases, along with citation search. The limitations of the search are explained in the discussion.

Results: A total of 569 results were found in PubMed and 721 results in Google Scholar. Due to the narrative nature of this review, no formal evaluation of the quality of evidence using standardised methods has been carried out. The non-protocolized selection of literature was made according to the consensus of the authors and based on professional relevance, type of study and availability of full text.

Conclusion: Hypertonic sodium lactate may represent a promising alternative within the portfolio of resuscitation fluids, with the potential to optimize circulating volume and improve the bioenergetics of cardiac performance while avoiding excessive fluid and chloride load. However, current evidence regarding its efficacy in patients with septic shock remains very limited and does not yet allow implementation of HSL into clinical practice. Despite the exponential increase in the number of HSL studies in recent years, robust randomized trials designed in accordance with the latest findings from basic research on lactate metabolism are still required to definitively assess its efficacy and safety.

Keywords: sepsis, septic shock, intravenous fluid therapy, hypertonic sodium lactate solution.

Received: May 16, 2025; Revised: September 14, 2025; Accepted: October 8, 2025; Prepublished online: November 26, 2025; Published: December 10, 2025  Show citation