Hypertonic saline solutions for treatment of intracranial hypertension

Abstract

Hypertonic saline solutions have evolved as an alternative to mannitol or may be used in otherwise refractory intracranial hypertension to treat raised intracranial pressure. With high osmolar loads, the efficacy of the solution is enhanced, but no simple relationship between the saline concentration and the clinical effects of a solution is established. Caution is advised with high osmolar loads because they carry increased risks for potentially deleterious consequences of hypernatremia or may induce osmotic blood-brain barrier opening with possibly harmful extravasation of the hypertonic solution into the brain tissue.

Management of Raised Intracranial Pressure

“…1 Algorithmic approach to a child with raised ICP 360 mosmol/Kg [14]. Concerns with its use are bleeding, rebound rise in ICP, hypokalemia, and hyperchloremic acidosis, central pontine myelinolysis, acute volume overload, renal failure, cardiac failure or pulmonary edema [15][16][17]. Despite these concerns, current evidence suggests that hypertonic saline as currently used is safe and does not result in major adverse effects [18].…”

Osmotherapy: Use Among Neurointensivists

“…Hypertonic saline is known to cause venous sclerosis [30], and concentrations above 2% are best administered via central venous catheter. Other reported adverse effects have included acute kidney injury, coagulopathy, exacerbation of congestive heart failure, hypokalemia, and seizure [25,31]. Central pontine myelinolysis is a potential risk, though it has never been reported in patients receiving HTS for treatment of cerebral edema.…”

Intensive Care Management of the Traumatic Brain Injury

“…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). In different studies the concentration of hypertonic saline used has varied from 1.7% to 30% (98).…”