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Hypertonic saline
From WikEM
Contents
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
- ↑ Holmes, J. Therapeutic uses of Hypertonic Saline in the Critically Ill Emergency Department Patient. EB Medicine 2013
- ↑ 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.
