Treatment of resistant intracranial hypertension with hypertonic saline

Abstract

The authors describe two patients with traumatic cerebral edema and intracranial hypertension in whom the continued use of mannitol and furosemide resulted in a progressive lessening of the effect of these agents on the intracranial pressure (ICP) and caused prerenal failure. Intravenous administration of hypertonic saline (50 ml and 20 ml of a 5-mmol/ml saline solution over 10 minutes in Cases 1 and 2, respectively) produced a prolonged reduction in the ICP and improved renal function in both cases. It is suggested that if a reduction in ICP without diuresis is required in patients with traumatic cerebral edema, treatment with intravenous hypertonic saline should be considered.

Effects of Hypertonic Saline Hydroxyethyl Starch Solution and Mannitol in Patients With Increased Intracranial Pressure After Stroke

“…46,47 A major effect on brain edema and ICP cannot be expected from colloid solutions, since the main determinant of water exchange in the brain is mediated by the osmotic pressure, whereas the oncotic pressure has no or only limited effect. 48 HS without dextrans or HES has been reported anecdotally to be successful in patients with intracranial hypertension 23 and is effective in animals. 15,[17][18][19]21,30,49 HS may possibly be as effective as HS-HES in reducing elevated ICP, in particular because HS-HES does not increase the SABP in euvolemic patients.…”

Management of intracranial hypertension: Recent advances and future directions

“…19 So,in search for an alternate therapy, in 1988 Worthley et al first found that HTS reduced ICP in patients that were refractory to mannitol. 52 As sodium has a reflection coefficient of 1 (compared to 0.9 for mannitol), HTS theoretically has an excellent osmotic action. Apart from hyperosmolar effect, other mechanisms of ICP reduction have also been proposed.…”

Effects of the drogs used as antiedema on the diffus cerebral edema. An experimental study in rats.

“…Mannitole dirençli kontrol edilemeyen ve idrar çıkışı olmayan yüksek KİB'li 2 hastaya %29,2'lik HTS'den 20 ml verildiği zaman renal işlev ve KİB'de düzelme göz-lenmiştir. [30] Tedaviye dirençli artmış KİB'li bir hastada tek doz %7,5'lik bolus HTS ile %50'nin üzerinde düzelme gözlenmiştir. [31] Suares, [32] mannitole dirençli 8 hastada %23,4 HTS'den 30 ml bolus şeklinde bir tedavi denemiştir.…”