Administration of hypertonic (3%) sodium chloride/acetate in hyponatremic patients with symptomatic vasospasm following subarachnoid hemorrhage.
A retrospective study was carried out to evaluate the effect of hypertonic (3%) saline chloride/acetate on various hemodynamic parameters in mildly hyponatremic patients with symptomatic vasospasm following aneurysmal subarachnoid hemorrhage (SAH). We identified 29 hyponatremic (serum sodium < 135 mEq/L) patients who received hypertonic (3%) sodium chloride/acetate as a continuous infusion. Administration of hypertonic (3%) sodium chloride/acetate resulted in higher central venous pressures and positive fluid balance, with a concomitant increase in serum sodium and chloride concentrations without metabolic acidosis. There were no changes in mean cerebral blood flow velocities after infusion of hypertonic (3%) sodium chloride/acetate. We found no reports of congestive heart failure, pulmonary edema, metabolic acidosis, coagulopathy, intracranial hemorrhages, or central pontine myelinolysis in any of these patients. We conclude that hypertonic (3%) sodium chloride/acetate can be administered to patients with mild hyponatremia in the setting of symptomatic vasospasm following SAH without untoward effects. Sample size and limitations of a retrospective analysis preclude conclusions about safety and efficacy of hypertonic (3%) sodium chloride/acetate administration in this patient population. However, our results support justification for a prospective, randomized, double-blind trial of hypertonic (3%) sodium chloride/acetate versus normal saline in patients with symptomatic vasospasm following SAH.
Division of Neurosciences Critical Care, The Johns Hopkins Medical Institutions, Baltimore, Maryland, USA.
J I
JI
Suarez
A I
AI
Qureshi
P D
PD
Parekh
A
A
Razumovsky
R J
RJ
Tamargo
A
A
Bhardwaj
J A
JA
Ulatowski
D000085:Acetates / Q000008:administration & dosage / Q000627:therapeutic use*; D000704:Analysis of Variance; D001783:Blood Flow Velocity / Q000187:drug effects; D002496:Central Venous Pressure / Q000187:drug effects; D002560:Cerebrovascular Circulation / Q000187:drug effects; D002712:Chlorides / Q000097:blood; D003329:Coronary Vasospasm / Q000000981:diagnostic imaging / Q000209:etiology*; D004311:Double-Blind Method; D005260:Female; D006439:Hemodynamics / Q000187:drug effects; D006801:Humans; D007010:Hyponatremia / Q000097:blood / Q000188:drug therapy*; D007262:Infusions, Intravenous; D002532:Intracranial Aneurysm / Q000150:complications; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D016032:Randomized Controlled Trials as Topic; D012189:Retrospective Studies; D012449:Safety; D012462:Saline Solution, Hypertonic / Q000008:administration & dosage / Q000627:therapeutic use*; D018401:Sample Size; D012964:Sodium / Q000097:blood; D013345:Subarachnoid Hemorrhage / Q000150:complications*; D017585:Ultrasonography, Doppler, Transcranial; D014882:Water-Electrolyte Balance / Q000187:drug effects
D000085:Acetates; D002712:Chlorides; D012462:Saline Solution, Hypertonic; D012964:Sodium