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Hypertonic Saline in the Critically Ill: A Review of Indications, Routes, and Dosing

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Abstract

Purpose of Review

In this article, we review the use of hypertonic saline (HTS) for FDA-approved indications, namely treatment of hyponatremia and elevated intracranial pressure (ICP), as well as the routes of administration appropriate for infusion.

Recent Findings

Though society guidelines for treating hyponatremia have not recently changed, new data is emerging that supports the use of bolus-based HTS treatment regimens. HTS is at least as effective as mannitol for lowering elevated ICP from cerebral edema and is also now the preferred hyperosmolar treatment in patients with intracranial hemorrhage (ICH) and traumatic brain injury (TBI). Central venous catheter (CVC) has been recommended in the past for HTS infusions, but emerging data suggest infusion via peripheral intravenous catheters (IV) is likely safe and may be worth avoiding the time intensive and potentially harmful process of placing a CVC.

Summary

HTS infusion via peripheral IV appears to be safe, effective, and more time efficient than infusion via CVC in treating acute hyponatremia and increased ICP.

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  1. Department of Emergency Medicine, The University of Kansas Health System, Mail Stop 3405, 3901, Rainbow Boulevard, Kansas City, KS, 66160, USA

    Jonathan Dangers, Maria Enders & Travis Helberg

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  1. Jonathan Dangers
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Correspondence to Jonathan Dangers.

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Dangers, J., Enders, M. & Helberg, T. Hypertonic Saline in the Critically Ill: A Review of Indications, Routes, and Dosing. Curr Emerg Hosp Med Rep 11, 95–102 (2023). https://doi.org/10.1007/s40138-023-00267-2

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