HTS has been shown to be safe and effective for reducing ICP and improving hemodynamics for the trauma patient in hemorrhagic shock. Currently, no convincing data show any improvement in clinical outcomes. HTS is an important therapy for patients with severe hyponatremia with signs of cerebral edema. A bolus of 100 mL of 3% saline is a reasonable start and may be repeated twice over 10-minute intervals to abate neurologic symptoms. Correction of a patient’s serum sodium < 10 to 12 mEq/L in the first 24 hours is unlikely to precipitate ODS. The theoretical benefits of HTS raise the possibility of its use as a therapy for other critically ill patients; however, little data exist to make any recommendations.
Jeffrey A. Holmes, MD
February 4, 2013