Hypertonic saline: First-line therapy for cerebral edema?

Effects of Decompressive Craniectomy, Hypertonic Saline Solution and Mannitol in an Experimental Model of Cerebral Ischemia

“…Schwarz et al [37] have demonstrated that infarction volume-reducing efficacy of 7.5% and 6.5% saline infusion was higher than that of mannitol treatment. Ziai et al [38] have emphasized that clinical practice is available with hypertonic saline in infarction associated with ischemic stroke, tumor-related edema, intracranial hemorrhage, postoperative retraction edema, and traumatic brain injury; however, attention should be paid during treatment for likely hypernatremia. In the present study, better efficacy in terms of decrease in ischemic volume was observed with low-dose hypertonic saline as compared with mannitol; however, the difference was not statistically significant.…”

Medical Management of Acute Ocular Hypertension in a Western Screech Owl (Megascops kennicottii)

“…24 A higher dose may have been more effective at reducing intraocular pressure to within normal limits. Although adverse effects of mannitol in raptors are not known, mannitol can cause hemolysis, hyperkalemia, hypotension, pulmonary edema, and renal insufficiency in humans 25 so its use may not be recommended in cases of reduced cardiac or renal function.…”

Intensive Care Management of the Traumatic Brain Injury

“…These may be preferred are renal failure or serum osmolality >320 mosmol/Kg too. It has been found effective in patients with serum osmolality of up to 360 mosmol/Kg (94). The expected complications with the use of hypertonic saline are bleeding, rebound rise in ICP, hyperchloremic acidosis and hypokalemia, central pontine myelinolysis, acute volume overload, renal failure, cardiac failure or pulmonary edema (95)(96)(97).…”

“…Propofol is widely used in the ICU to sedate intubated neurolojic patients with increased ICP (94) . Propofol has been shown to maintain or reduce ICP while maintaining an adequate CPP (95) .…”