Review article: Hypertonic saline use in the emergency department

Abstract

Hypertonic saline (HS) is being increasingly used for the management of a variety of conditions, most notably raised intracranial pressure. This article reviews the available evidence on HS solutions as they relate to emergency medicine, and develops a set of recommendations for its use. To conclude, HS is recommended as an alternative to mannitol for treating raised intracranial pressure in traumatic brain injury. HS is also recommended for treating severe and symptomatic hyponatremia, and is worth considering for both recalcitrant tricyclic antidepressant toxicity and for cerebral oedema complicating paediatric diabetic ketoacidosis. HS is not recommended for hypovolaemic resuscitation.

Airway management and initial resuscitation of the trauma patient

“…The intracranial pressure (ICP)-lowering effects and blood pressure-increasing effects of hypertonic saline suggest that future studies in brain injury patients are warranted. Currently, routine use of hypertonic saline bolus for hemorrhagic volume resuscitation is not recommended [33 ].…”

Resuscitation with Hypertonic Saline–Dextran Reduces Serum Biomarker Levels and Correlates with Outcome in Severe Traumatic Brain Injury Patients

“…Hypertonic saline solutions used at various concentrations (from 3% to 23.4%) have received renewed attention as effective osmotherapeutic agents for cerebral resuscitation with the capacity to limit secondary injury processes and to reduce cerebral edema and global ischemia in a variety of brain injury paradigms (Banks and Furyk, 2008;Himmelseher, 2007;Jantzen, 2007;Ogden et al, 2005;Popp and Bottinger, 2006;Rangel-Castillo and Robertson, 2006;Rhoney and Parker, 2006;Suarez, 2004;Tommasino and Picozzi, 2007). However, to the best of our knowledge, this is the first human study to provide clear evidence that hypertonic resuscitation is associated with reductions in the concentrations of circulating brain-injury biomarkers in severe TBI patients.…”

Beneficial Effect of Hypertonic Saline Resuscitation in a Porcine Model of Severe Acute Pancreatitis

“…The body weights of the animals did not differ among the 3 groups at baseline (group A, 25 In parenchyma (50% of lobules) 3…”

“…19,20 Thus, large amounts of crystalloid fluid are frequently required in the initial treatment of SAP. The application of HTS was shown to be beneficial in experimental acute pancreatitis 12,21Y24 because HTS infusion led to plasma expansion through a redistribution of fluid from the extravascular space, 25 which increased MAP and reduced the total volume dose. 2 However, most of these animal studies were performed on rodents.…”

“…In summary, our data strongly suggest that the administration of HTS could improve peripheral tissue perfusion and oxygenation, which is in accordance to several previous studies. 6,21,25 The possible underlying mechanisms of the improvement include vasodilatation of precapillary resistance vessels and cardiac preload enhancement. 28,29 In this study, we detected very severe pancreatic necrosis in both HTS and LR animals, and no histologic difference was found between the 2 groups.…”