Abstract
Background
Hypertonic saline is routinely used to treat rises in intracranial pressure (ICP) post-traumatic head injury. Repeated doses often cause a hyperchloremic metabolic acidosis. We investigated the efficacy of 8.4% sodium bicarbonate as an alternative method of lowering ICP without generating a metabolic acidosis.
Methods
We prospectively studied 10 episodes of unprovoked ICP rise in 7 patients treated with 85 ml of 8.4% sodium bicarbonate in place of our usual 100 ml 5% saline. We measured ICP and mean arterial pressure continuously for 6 h after infusion. Serum pH, pCO2, [Na+], and [Cl−] were measured at baseline, 30 min, 60 min and then hourly for 6 h.
Results
At the completion of the infusion (t = 30 min), the mean ICP fell from 28.5 mmHg (±2.62) to 10.33 mmHg (±1.89), P < 0.01. Mean ICP remained below 20 mmHg at all time points for 6 h. Mean arterial pressure was unchanged leading to an increased cerebral perfusion pressure at all time points for 6 h post-infusion. pH was elevated from 7.45 ± 0.05 at baseline to 7.50 ± 0.05, P < 0.01 at t = 30 min, and remained elevated. Serum [Na+] increased from 145.4 ± 6.02 to 147.1 ± 6.3 mmol/l, P < 0.01 at t = 30 min. pCO2 did not change.
Conclusions
A single dose of 8.4% sodium bicarbonate is effective at treating rises in ICP for at least 6 h. Serum sodium was raised but without generation of a hyperchloremic metabolic acidosis.
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References
Clayton TJ, Nelson RJ, Manara AR. Reduction in mortality from severe head injury following introduction of a protocol for intensive care management. Br J Anaesth. 2004;93(6):753–5.
Vukic M, Negovetic L, Kovac D, Ghajar J, Glavic Z, Gopcevic A. The effect of implementation of guidelines for the management of severe head injury on patient treatment and outcome. Acta Neurochir (Wien). 1999;141:1203–8.
White H, Cook D, Venkatesh B. The use of hypertonic saline for treating intracranial hypertension after traumatic brain injury. Anesth Analg. 2006;102(6):1836–46.
Scheingraber S, Rehm M, Sehmisch C, Finsterer U. Rapid saline infusion produces hyperchloremic acidosis in patients under- going gynecologic surgery. Anesthesiology. 1999;90:1265–70.
Waters JH, Miller LR, Clack S, Kim JV. Cause of metabolic acidosis in prolonged surgery. Crit Care Med. 1999;27:2142–6.
Stefan Schwarz MD, Dimitrios Georgiadis MD, Alfred Aschoff MD, Stefan Schwab MD. Effects of hypertonic (10%) saline in patients with raised intracranial pressure after stroke. Stroke. 2002;33:136–40.
Qureshi AI, Suarez JI, Bhardwaj A, Mirski M, Schnitzer MS, Hanley DF, Ulatowski JA. Use of hypertonic (3%) saline/acetate infusion in the treatment of cerebral edema: effect on intracranial pressure and lateral displacement of the brain. Crit Care Med. 1998;26:440–6.
Wilcox CS. Regulation of renal blood flow by plasma chloride. J Clin Invest. 1983;71:726–35.
Hansen PB, Jensen BL, Skott O. Chloride regulates afferent arteriolar contraction in response to depolarization. Hypertension. 1998;32:1066–70.
Wilkes NJ, Woolf R, Mutch M, et al. The effects of balanced versus saline-based hetastarch and crystalloid solutions on acid–base and electrolyte status and gastric mucosal perfusion in elderly surgical patients. Anesth Analg. 2001;93:811–6.
Williams EL, Hildebrand KL, McCormick SA, Bedel MJ. The effect of intravenous lactated Ringer’s solution versus 0.9% sodium chloride solution on serum osmolality in human volunteers. Anesth Analg. 1999;88:999–1003.
Waters JH, Gottlieb A, Schoenwald P, Popovich MJ, Sprung J, Nelson DR. Normal saline versus lactated Ringer’s solution for intraoperative fluid management in patients undergoing abdominal aortic aneurysm repair: an outcome study. Anesth Analg. 2001;93:817–22.
Doyle JA, Davis DP, Hoyt DB. The use of hypertonic saline in the treatment of traumatic brain injury. J Trauma. 2001;50(2):367–83.
Weed LH, McKibben PS. Pressure changes in the cerebro spinal fluid following intravenous injection of solutions of various concentrations. Am J Physiol. 1919;48(4):512–30.
Weed LH, McKibben PS. Experimental alteration of brain bulk. Am J Physiol. 1919;48(4):531–58.
Young RS, Yagel SK, Woods CL. The effects of sodium bicarbonate on brain blood flow, brain water content, and blood-brain barrier in the neonatal dog. Acta Neuropathol (Berl). 1984;65:124–7.
Nakashima K, Yamashita T, Kashiwagi S, Nakayama N, Kitahara T, Ito H. The effect of sodium bicarbonate on CBF and intracellular pH in man: stable Xe-CT and 31P-MRS. Acta Neurol Scand. 1996;166(Suppl):96–8.
Schieve JF, Wilson WP. The changes in cerebral resistance of man in experimental alkalosis and acidosis. J Clin Invest. 1953;32:33–8.
Acknowledgments
The authors would like to thank Dr Will English for his help preparing the protocol and all the nursing staff at Frenchay Hospital Intensive Care Unit for their help and support of this study.
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Bourdeaux, C., Brown, J. Sodium Bicarbonate Lowers Intracranial Pressure After Traumatic Brain Injury. Neurocrit Care 13, 24–28 (2010). https://doi.org/10.1007/s12028-010-9368-8
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DOI: https://doi.org/10.1007/s12028-010-9368-8