<< Therapeutic Uses Of Hypertonic Saline In The Critically Ill Emergency Department Patient (Trauma CME)

Tools And Techniques: Practical Considerations For Hypertonic Saline

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Tools And Techniques: Practical Considerations For Hypertonic Saline

Tools And Techniques: Practical Considerations For Hypertonic Saline

HTS for the trauma patient with TBI and/or hemorrhagic shock is most often infused as a single 250-mL IV bolus of 7.5% NaCl solution with 60% dextran 70. An alternative weight-based bolus of 4 mL/kg has also been used.

The military has examined the intraosseous route as an alternative method for infusing resuscitation fluids for the treatment of hemorrhagic shock in animals. It appears to be as effective in restoring MAP as the IV route,64-66 and no short- or long-term major tissue damage was observed. Caution should still be exercised, however, as extravasated hypertonic fluid has the potential to cause tissue necrosis. This may have accounted for 1 study reporting tibial necrosis 2 days after the infusion of HTS with dextran into dehydrated pigs.67

For the treatment of severe hyponatremia, 100 mL of 3% HTS saline should be given as an IV bolus. This should raise the serum sodium concentration by 2 to 3 mEq/L. Be careful, as the serum sodium may autocorrect and rise faster than expected. Some experts suggest a target increase of no more than 8 to 10 mEq/L/d.

Due to the high osmolarity of HTS, infusion through a central line is preferred to minimize phlebitis.68 Most studies used a 7.5% HTS solution, which has an osmolarity of 2567 mOsm/L. The usual maximum recommended osmolarity infused via a peripheral IV line is 900 mOsm/L. For this reason, when central access is not available, it is advisable to administer HTS through a large-bore peripheral IV line.

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