Effect of ATP-MgCl2-glucose administration during hemorrhagic shock on cardiovascular function, metabolism, and survival.

Both exogenous glucose and adenosine triphosphate--magnesium chloride (ATP-MgCl2, used separately, have been reported to prolong survival after hemorrhagic shock. The purpose of this study was to determine whether intravenously administered glucose plus ATP-MgCl2 given together during hemorrhagic shock would improve cardiac function and survival. Further, we investigated whether glucose had any real additive effect when used in conjunction with ATP-MgCl2, by using ATP-MgCl2 alone and with equimolar mannitol. Awake pigs were bled 40% of total blood volume within 10 minutes. Five pigs received no treatment; 4 received lactated Ringer's equivalent to the initial bled volume; 5 received ATP (206 microM/kg), MgCl2 (206 microM/kg) and glucose (0.5 g/kg); 5 received ATP-MgCl2, glucose and lactated Ringer's; 5 received ATP-MgCl2 alone, and 6 received ATP-MgCl2 and mannitol (0.5 g/kg). All treated groups received sodium bicarbonate (2 mEq/kg). Duration of this experiment was 240 minutes. Mean survival of those which received no treatment was 36.8 +/- SE 2.9 minutes; those which received ATP-MgCl2-glucose had a significantly longer survival with a mean of 157.6 +/- 12.0 minutes (p less than 0.05). With Ringers' alone, the mean survival was 92.6 +/- 0.7 minutes and those which received ATP-MgCl2-glucose plus Ringer's had a significantly greater mean survival of 159-0 +/- 2.7 minutes (p less than 0.05). Mean survival of those which received ATP-MgCl2-mannitol was statistically significantly greater at 200.8 +/- 10.3 minutes than ATP-MgCl2-glucose alone with Ringer's (p less than 0.01). Mean survival was greatest in those which received ATP-MgCl2 alone at 201.2 +/- 9.5 minutes (p less than 0.01), and statistically significantly greater than any other treatment group except ATP-MgCl2-mannitol. ATP-MgCl2 alone significantly increased survival compared to those which received ATP-MgCl2-glucose.