CICM SAQ 2010.2 Q1

1.1. 1) Briefly outline the rationale for the use of hypertonic saline in Hyponatremia

• Severe hyponatremia (<120 mEq/L) can cause significant and permanent neurologic injury or death. In the event of seizures or acute collapse relatively rapid initial correction may be required.
• There is evidence that the severity and duration of hyponatremia may be related to cerebropontine myelinolysis, normal saline and fluid restriction may be inadequate to increase sodium levels appropriately.
• Some conditions such as cerebral salt wasting or large GIT losses may result in losses that may not be able to be replaced by other means.

1.1. 2) Briefly outline the rationale for the use of hypertonic saline in Traumatic brain injury

• The rationale for hypertonic saline compared with normal saline
• Better compensates for blood loss
• Improved CPP
• Reduces harmful inflammatory responses
• May prevent cerebral edema.
• Can be used as a continuous infusion
• Obviates the need for osmolality testing

Previous animal studies and smaller clinical trials suggested better outcomes in patients with TBI after use of hypertonic saline solution. The safety profile has been good, and some evidence suggests a potential survival benefit when hypertonic saline is given. However The National Heart, Lung, and Blood Institute (NHLBI) of the National Institutes of Health (NIH) has stopped enrollment of patients with severe traumatic brain injury (TBI) into a Resuscitation Outcomes Consortium (ROC) trial testing the effects of hypertonic saline solutions given before arrival at the emergency department. as early as possible after TBI. 1073 patients 6 month analysis – no difference.

1.2 List the possible complications of hypertonic saline administration.

• Hypernatremia
• Hyperchloraemic acidaemia
• Renal failure
• CCF/Pulmonary Oedema
• Neurological SAH
• rebound intracranial H/T
• Central Pontine Myelinolysis