Hypertonic saline: patterns of and guidelines for use.
Guidelines for appropriate use of hypertonic (3%) saline (HS) for the treatment of hyponatremia are ill-defined. We reviewed each infusion of HS in a 400-bed university hospital over a 1-year period. Of the 14 infusions, the hyponatremia (average serum sodium [Na+] 19.9 +/- 6.7 mEq/L) was chronic in 11 cases and acute in only 3. In only 2 patients were there symptoms possibly attributable to hyponatremia. On the average, more than 5 hours elapsed from the last measured serum Na+ level to the initiation of HS infusion, and the next measured serum Na+ value came more than 6 hours later. HS should be reserved for symptomatically hyponatremic patients, most of whom become acutely hyponatremic. A target level for the serum Na+ should be determined and a time-course for correction set. The infusion should be started promptly and monitored frequently for the effect on the serum Na+ level and patient symptoms.
Department of Internal Medicine, University of South Alabama, College of Medicine, Mobile 36617.
R M
RM
Culpepper
B D
BD
Clements
S R
SR
Pence
D000328:Adult; D000368:Aged; D001806:Blood Urea Nitrogen; D002648:Child; D002675:Child, Preschool; D005260:Female; D017408:Guidelines as Topic; D006801:Humans; D007010:Hyponatremia / Q000097:blood / Q000188:drug therapy*; D007902:Length of Stay; D008297:Male; D009994:Osmolar Concentration; D012462:Saline Solution, Hypertonic / Q000008:administration & dosage*; D012964:Sodium / Q000097:blood
D012462:Saline Solution, Hypertonic; D012964:Sodium