Hypertonic saline

Administration

  • Type: Osmotherapy, electrolyte/IVF
  • Dosage Forms:
    • 3% (513mEq/L)
    • 5% (856mEq/L)
    • 23.4% (4000mEq/L)
  • Nebulized (as adjunct for bronchiolitis, cystic fibrosis)

Adult Dosing

Symptomatic Hyponatremia

  • Bolus 100-250mL 3% NS 100cc bolus over 10min; repeat after 10min x1 if no improvement

Elevated ICP

  • Most studies used 250 mL bolus of 7.5% NS with dextran[1]
  • Initial 250mL bolus of 3% will reduce ICP and can be delivered through a peripheral line
  • Target Na 145-155 meq/dL

Pediatric Dosing

  • Symptomatic hyponatremia: 2mL/kg of 3% over 10-60 minutes, repeat of up to 3 times
  • Elevated ICP
    • 3% NS: 3-10 mL/kg over 10-60 minutes[2]
    • Titrate to serum Na 145-150

Special Populations

Renal Dosing

  • Adult:
  • Pediatric:

Hepatic Dosing

  • Adult:
  • Pediatric:

Contraindications

  • Allergy to class/drug
  • Hypernatremia
  • Chronic hyponatremia
  • Severe CHF (theoretical), volume overload

Adverse Reactions

Serious

  • Hypotension(infusion rate-related)
  • Metabolic acidosis
  • Hypernatraemia
  • Hypokalemia
  • Volume overload
  • Renal failure
  • Coagulopathy
  • Phlebitis, tissue necrosis if extravasates (need central line for concentrations >3%
  • If Na+ corrected too quickly, central pontine myelinosis, seizure, encephalopathy

Common

Pharmacology

  • Half-life: rapid onset of action (~10min), effect lasts ~1hr
  • Metabolism:
  • Excretion:

Mechanism of Action

  • Raises serum Na+, osmotherapy

Comments

See Also

References

  1. Holmes, J. Therapeutic uses of Hypertonic Saline in the Critically Ill Emergency Department Patient. EB Medicine 2013
  2. Kochanek PM, Carney N, Adelson PD, et al. Guidelines for the acute medical management of severe traumatic brain injury in infants, children, and adolescents--second edition. Pediatr Crit Care Med. 2012;13 Suppl 1:S1-82.