Prolonged Hypernatremia Controls Elevated Intracranial Pressure in Head Injured Pediatric Patients

Salt of the earth or a drop in the ocean? A pathophysiological approach to fluid resuscitation

“…Clinical studies after head trauma suggest that early infusion of hypertonic solutions reduce intracranial pressure, increase cerebral perfusion pressure, and improve outcome, compared with isotonic resuscitation. [35][36][37] However, in patients with head injury who are also hypovolaemic, hypertonic solutions are only of benefit during early care, and should not be the sole form of resuscitation. 38 Clinical studies of the use of hypertonic solutions for treatment of hypovolaemic shock have not shown consistent benefit in terms of mortality or morbidity, however this may be attributable to the complexities of the clinical models used and the variable effects of hypertonic solutions.…”

Operational Anaesthesia for the Management of Traumatic Brain Injury

“…Hypertonic saline (HTS) has been shown to lower ICP in severe head injuries and in multiple studies has been shown to improve neurological outcome in TBI [18][19][20][21] especially in paediatric patients [22][23][24][25][26]. It may have other beneficial effects such as increasing circulating volume, minimal alteration to coagulation and anti-inflammatory properties [27].…”

New Concepts in Treatment of Pediatric Traumatic Brain Injury

“…In our pediatric institution, 2-6 ml/kg as an initial bolus dose is commonly used. Continuous infusions of 0.1 to 1 ml/kg/hour titrated to maintain ICP < 20 mmHg have also been reported 108,109. While the guidelines state that 3 % saline will not precipitate renal failure as long as serum osmolality is < 360 mOsm/l 1, caution should be exercised if the serum osmolality approaches 320 mOsm/l as there may be an increased risk for renal insufficiency 60.…”

“…Another theoretical concern with the use of hypertonic saline is subarachnoid hemorrhage due to rapid shrinking of the brain associated with mechanical tearing of the bridging vessels- this has not been clinically reported. Rebound intracranial hypertension has been described clinically with the use of hypertonic saline bolus administration or after stopping the continuous infusion 108,111.…”