Administering Hypertonic Saline to Patients With Severe Traumatic Brain Injury

Diane Schretzman Mortimer; Jon Jancik

Disclosures

J Neurosci Nurs. 2006;38(3):142-146. 

In This Article

Administering HTS in Special Situations

HTS can also be administered in bolus form to treat acute ICP elevations. A dose of highly concentrated HTS, such as 30 ml of 23.4% NaCl, is given through a central line over approximately 15 min (Suarez et al., 1998). The bolus dose of HTS can help decrease ICP and improve cerebral perfusion (Horn et al., 1999; Qureshi & Suarez, 2000).

Studies indicate that bolus HTS therapy can be administered as frequently as every 6 hrs. Interestingly, a bolus of 23.4% NaCl does not cause considerable increases in serum osmolarity or serum sodium levels. This therapy can be administered even if serum sodium levels are at high end of the goal range. It is nonetheless prudent to closely monitor laboratory values. If a patient's serum sodium or osmolarity levels begin to rise, the frequency of boluses may need to be decreased (Suarez et al., 1998).

HTS is attractive as a resuscitation fluid because it can help achieve hemodynamic stabilization, which can optimize brain perfusion. HTS can achieve these effects with smaller volumes than hypotonic or isotonic intravenous fluids. It can be beneficial for patients to receive smaller amounts of fluid to prevent exacerbations of cerebral edema and increases in ICP (Cooper et al., 2004; Kramer, 2003; Shackford et al., 1998; Wright, 1999).

A drawback to using HTS in the resuscitation phase is that clinicians need to know the patient's serum sodium levels before initiating HTS therapy. If the initial serum sodium level is 130 mmol/L or lower, a rapid increase could cause central pontine myelinolysis, a devastating complication. Emergency providers, therefore, should not administer HTS to hyponatremic patients. It may be difficult for paramedics and emergency room staff members to assess this important laboratory value soon enough to resuscitate with HTS. In the future, if emergency care providers can assess the serum sodium levels more quickly, resuscitation with HTS may become more common (Kramer, 2003).

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