Hank's Balanced Salt Solution (HBSS): Composition, Storage, and Clinical Use
What is Hank's Balanced Salt Solution?
Hank's Balanced Salt Solution is a physiologically balanced mixture of salts designed to maintain cell viability in vitro, but it is NOT appropriate for intravenous or in-vivo therapeutic use in humans. 1
HBSS is a laboratory reagent specifically formulated for cell culture and tissue preservation applications, not for systemic administration. 2
Composition
HBSS contains the following components per liter: 1
- Calcium chloride (CaCl₂): 0.14 g/L
- Potassium chloride (KCl): 0.40 g/L
- Potassium phosphate (KH₂PO₄): 0.06 g/L
- Magnesium chloride hexahydrate (MgCl₂·6H₂O): 0.10 g/L
- Magnesium sulfate heptahydrate (MgSO₄·7H₂O): 0.10 g/L
- Sodium chloride (NaCl): 8.00 g/L
- Sodium bicarbonate (NaHCO₃): 0.35 g/L
- Sodium phosphate (Na₂HPO₄): 0.048 g/L
- Glucose: 1.00 g/L
- Phenol red: 0.01 g/L (pH indicator)
This bicarbonate-rich formulation maintains physiological pH and osmolarity for cell preservation. 1
Storage Conditions
HBSS should be stored according to standard laboratory reagent protocols, typically refrigerated at 2-8°C when not in use. 2 The solution is designed for short-term cell and tissue preservation, not long-term storage or systemic administration. 3
Appropriate Clinical Uses
✓ APPROVED: Dental Avulsion Storage Medium
HBSS is highly effective as a storage medium for avulsed (knocked-out) permanent teeth and ranks as the preferred solution for preserving periodontal ligament cell viability. 1
- HBSS demonstrates superior periodontal ligament cell viability compared to tap water and saline solution. 4
- When immediate tooth replantation is not possible, HBSS should be the first-choice storage medium if available. 1
- HBSS maintains cell viability for up to 24 hours, significantly longer than milk (effective for only 6-12 hours). 3
- The 2024 American Heart Association and American Red Cross guidelines recommend HBSS as the top-tier storage solution for avulsed teeth. 1
Alternative storage media (in descending order of effectiveness when HBSS is unavailable): 1
- Oral rehydration salt solutions
- Propolis
- Rice water (if preprepared)
- Cling film wrap
- Cow's milk
- Saliva
✗ NOT APPROVED: Intravenous or Systemic Therapeutic Use
HBSS is absolutely contraindicated for intravenous administration or any in-vivo therapeutic use in humans. This is a critical safety distinction that must be emphasized.
The evidence provided discusses hypertonic saline solutions (3-30% NaCl) for IV use, which are entirely different from HBSS: 1
- Hypertonic saline (3-7.5% NaCl) is NOT recommended for volume resuscitation in hemorrhagic shock (GRADE 1- strong recommendation). 1, 5
- Hypertonic saline may be used specifically for intracranial hypertension management in traumatic brain injury with focal neurological signs. 5, 6
- For general IV fluid therapy, balanced crystalloids (Ringer's Lactate, Plasmalyte) are recommended as first-line treatment. 7
Common Pitfalls to Avoid
Never confuse HBSS with IV saline solutions: HBSS is a laboratory reagent, not a pharmaceutical-grade IV fluid. 2
Do not use HBSS for volume resuscitation: Even though it contains salts, HBSS lacks the appropriate composition, sterility standards, and regulatory approval for systemic administration. 1
Recognize formulation variations: Published formulations of HBSS may vary significantly from the original composition, which can affect cell culture results. 2
Time-sensitive application for dental avulsions: HBSS effectiveness decreases over time; teeth should be replanted or reach definitive dental care as quickly as possible, ideally within hours. 1