- May reduce ICP in patients refractory to mannitol
- Potentially deleterious effect on stroke penumbra in animal studies.
- Benefit
- Osmotic action → reduce ICP
- Vasoregulatory
- Immunological
- Neurochemical actions;
- Expands intravascular volume → augmenting CPP.
- Mechanism of action
- Osmotic effect by drying out endothelial cells → water to move from CSF to cerebral vessels
- Does not have a strong diuretic effect because it can be reabsorbed by in the kidney
- Contra indication
- Congestive heart failure or renal insufficiency due to their already increased fluid and sodium loads
- Side effects
- Hyperchloremic metabolic acidosis due to the addition of NaCl.
- Route specific
- Thrombophlebitis
- Extravasation
- Studies are not adequate to make recommendations regarding use.
- ℞:
- Continuous infusion: 3% saline at 25–50 ml/hr may be given through a peripheral IV.
- Bolus: 10–20ml of 7.5–23.4% saline must be given through a central line.
- 3mL/kg over 20min, raising serum sodium by around 2-3mmol/L
- Stop
- HS should be discontinued after ≈ 72 hours to avoid rebound edema.
- Hold if serum osmolarity > 320 mOsm/L.
- Vs Mannitol
- Mangat, 2014:
- HTS was more effective in lowering ICP burden but did not have a significant effect on mortality.
- Hypertonic saline better than mannitol in reducing ICP while maintaining CCP (in the form of total number/% of days in High ICP and low CPP states)
- Diringer 2013:
- HS may have a more profound and long- lasting effect on ICP compared with mannitol, but outcome benefits over mannitol have not been demonstrated.
- Mannitol has haemodynamic, osmotic and diuretic effects
- HS has osmotic and diuretic effects
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