Massachusetts General Hospital

Department of Pharmacy

Department of Nursing

Critical Care

Generic Name: Sodium Chloride 23.4%

Trade Name: Hypertonic Saline

Action: Decreases intracranial pressure by enhancement of cerebral blood flow across the blood brain barrier: augmentation of intravascular volume

Indications: Emergent reduction of increased intracranial pressure, intracranial hypertension and cerebral edema during actively monitored ICPs.

Administration Guidelines:

Usual Adult Dosage and Range: 23.4 % NaCl ( 4mEq/ml) 30 mls delivered IVP over 10-20 minutes via a controlled infusion device. Central line preferred but not necessary.

Special Considerations:

• Restricted to the Neuro-Sciences Intensive Care Unit or in the presence of an attending neurologist.
• Patient must have continuous ICP monitoring
• Infusion rate related hypotension has been observed if given over suggested rate of infusion
• Dilution of vial not necessary.

Precautions and Side Effects:

• Hyperosmolarity, hypernatremia, hyperchloremia, hypokalemia
• Central pontine mylinolysis
• Congestive Heart Failure, hypotension, hypertension, fluid overload
• Pregnancy and lactation effect unknown
• Thrombophlebitis

References:

Qureshi, A, Suarez,J ( 2000) Use of hypertonic saline solutions in treatment of cerebral edema and intracranial hypertension. Critical Care Medicine, Vol. 28,No9, pg. 3301-3313.

Suarez,J, Qureshi, A., et al ( 1998) Treatment of refractory intracranial hypertension with 23.4% saline. Critical Care Medicine, Vol 26, No 6.pg. 1118-1122.