Saturday April 14, 2007
HYPERTONIC SALINE THERAPY

Hypertonic saline is administered for a wide variety of conditions, and this multitude of indications can sometimes seem confusing. Currently, there are 3 primary indications for the use of hypertonic saline in critically ill patients:

• hyponatremic states,
• volume resuscitation in shock,
• brain injury and
• Miscellaneous

Hyponatremic states

1. Syndrome of inappropriate antidiuretic hormone (occasionally indicated)
2. Cerebral salt-wasting syndrome (indicated if hyponatremia
is significant)

3. Other causes (rarely indicated)

• Psychogenic polydipsia
• Diuretic overuse/abuse
• Addison disease
• Excessive losses of gastrointestinal secretions
• Late-stage cirrhosis, congestive heart failure, or renal disease

Volume resuscitation in shock (may be beneficial)

• Hemorrhagic shock
• Septic shock
• Major burns
  

Brain injury (may be beneficial) Traumatic or nontraumatic


Miscellaneous uses

Oral (largely historical)

• Heat-related disorders
• Orthostatic hypotension
• Cystic fibrosis

Parenteral uses

• Sclerotherapy (injected directly into affected vein)
• After coronary artery bypass surgery (intravenous)
• Leishmaniasis (intradermal)
• Midtrimester abortion (intra-amniotic)
  

Related previous pearl:
Hypertonic Solution (3% NS) in cerebral edema and intracranial hypertension