Hypertonic saline: Difference between revisions
ClaireLewis (talk | contribs) No edit summary |
|||
| Line 8: | Line 8: | ||
==Adult Dosing== | ==Adult Dosing== | ||
===Symptomatic Hyponatremia=== | ===Symptomatic [[Hyponatremia]]=== | ||
*Bolus 100-250mL 3% NS 100cc bolus over 10min; repeat after 10min x1 if no improvement | *Bolus 100-250mL 3% NS 100cc bolus over 10min; repeat after 10min x1 if no improvement | ||
===Elevated ICP=== | ===[[Elevated ICP]]=== | ||
*Most studies used 250 mL bolus of 7.5% HTS with dextran<ref>Holmes, J. Therapeutic uses of Hypertonic Saline in the Critically Ill Emergency Department Patient. EB Medicine 2013</ref> | *Most studies used 250 mL bolus of 7.5% HTS with dextran<ref>Holmes, J. Therapeutic uses of Hypertonic Saline in the Critically Ill Emergency Department Patient. EB Medicine 2013</ref> | ||
*Initial 250mL bolus of 3% will reduce ICP and can be delivered through a peripheral line | *Initial 250mL bolus of 3% will reduce ICP and can be delivered through a peripheral line | ||
| Line 16: | Line 16: | ||
==Pediatric Dosing== | ==Pediatric Dosing== | ||
*Symptomatic hyponatremia: 2mL/kg of 3% over 10-60 minutes, repeat of up to 3 times | *Symptomatic [[hyponatremia]]: 2mL/kg of 3% over 10-60 minutes, repeat of up to 3 times | ||
*Elevated ICP | *[[Elevated ICP]] | ||
**3% NS: 3-10 mL/kg over 10-60 minutes<ref>Kochanek PM, Carney N, Adelson PD, et al. Guidelines for the acute medical management of severe traumatic brain injury in infants, children, and adolescents--second edition. Pediatr Crit Care Med. 2012;13 Suppl 1:S1-82.</ref> | **3% NS: 3-10 mL/kg over 10-60 minutes<ref>Kochanek PM, Carney N, Adelson PD, et al. Guidelines for the acute medical management of severe traumatic brain injury in infants, children, and adolescents--second edition. Pediatr Crit Care Med. 2012;13 Suppl 1:S1-82.</ref> | ||
**Titrate to serum Na 145-150 | **Titrate to serum Na 145-150 | ||
==Special Populations== | ==Special Populations== | ||
*[[Drug Ratings in Pregnancy|Pregnancy Rating]]: | *[[Drug Ratings in Pregnancy|Pregnancy Rating]]: C | ||
*[[Lactation risk categories|Lactation risk]]: | *[[Lactation risk categories|Lactation risk]]: Infant risk minimal | ||
===Renal Dosing=== | ===Renal Dosing=== | ||
*Adult: | *Adult: | ||
| Line 69: | Line 69: | ||
<references/> | <references/> | ||
[[Category:Pharmacology]] | [[Category:Pharmacology]] | ||
[[Category:FEN]] | |||
Latest revision as of 20:28, 22 September 2019
Administration
- Type: Osmotherapy, electrolyte/IVF
- Dosage Forms:
- 3% (513mEq/L)
- 5% (856mEq/L)
- 23.4% (4000mEq/L)
- Nebulized (as adjunct for bronchiolitis, cystic fibrosis)
Adult Dosing
Symptomatic Hyponatremia
- Bolus 100-250mL 3% NS 100cc bolus over 10min; repeat after 10min x1 if no improvement
Elevated ICP
- Most studies used 250 mL bolus of 7.5% HTS with dextran[1]
- Initial 250mL bolus of 3% will reduce ICP and can be delivered through a peripheral line
- Target Na 145-155 meq/dL
Pediatric Dosing
- Symptomatic hyponatremia: 2mL/kg of 3% over 10-60 minutes, repeat of up to 3 times
- Elevated ICP
- 3% NS: 3-10 mL/kg over 10-60 minutes[2]
- Titrate to serum Na 145-150
Special Populations
- Pregnancy Rating: C
- Lactation risk: Infant risk minimal
Renal Dosing
- Adult:
- Pediatric:
Hepatic Dosing
- Adult:
- Pediatric:
Contraindications
- Allergy to class/drug
- Hypernatremia
- Chronic hyponatremia
- Severe CHF (theoretical), volume overload
Adverse Reactions
Serious
- Hypotension(infusion rate-related)
- Metabolic acidosis
- Hypernatraemia
- Hypokalemia
- Volume overload
- Renal failure
- Coagulopathy
- Phlebitis, tissue necrosis if extravasates (need central line for concentrations >3%
- If Na+ corrected too quickly, central pontine myelinosis, seizure, encephalopathy
Common
Pharmacology
- Half-life: rapid onset of action (~10min), effect lasts ~1hr
- Metabolism:
- Excretion:
Mechanism of Action
- Raises serum Na+, osmotherapy
Comments
See Also
References
- ↑ Holmes, J. Therapeutic uses of Hypertonic Saline in the Critically Ill Emergency Department Patient. EB Medicine 2013
- ↑ Kochanek PM, Carney N, Adelson PD, et al. Guidelines for the acute medical management of severe traumatic brain injury in infants, children, and adolescents--second edition. Pediatr Crit Care Med. 2012;13 Suppl 1:S1-82.