title: Repeated dosing of 23.4% hypertonic saline for refractory intracranial hypertension. A case report.
abstract: BACKGROUND
  Hypertonic saline (HTS) at a concentration of 23.4% is an emerging therapy for intracranial hypertension. Compared to mannitol which can be given as a single bolus or as repeated bolus dosing, little data exists regarding safety or efficacy of repeated dosing of 23.4% HTS. We report the first case of 16 doses of 23.4% HTS over a 5 day period in a patient with refractory intracranial hypertension.
  
  
  METHODS
  A 43-year-old woman with Fisher 3 subarachnoid hemorrhage and hydrocephalus requiring an external ventricular drain developed global cerebral edema on computed tomography. Medically refractory intracranial hypertension ensued which required repeated dosing of 23.4% HTS. Reductions in intracranial pressure (ICP) occurred after each dose of 23.4% HTS. No central nervous system complications occurred. Anasarca was the only observed complication, which responded to furosemide diuresis.
  
  
  CONCLUSIONS
  Repeated dosing of 23.4% HTS was effective in reducing ICP in a case of medically refractory intracranial hypertension without major systemic complications. Prospective studies should address the safety and efficacy of repeat dose 23.4% HTS on serum sodium, intracranial pressure, and complications.
authors.affiliation: Departments of Pharmacy (AKV, KMN), Neuroradiology (DAM), Neurosurgery (RAH) and Neurology (WDF), Mayo Clinic, Jacksonville, FL.
authors.forename: Alden K
authors.initials: AK
authors.lastname: Valentino
authors.forename: Karen M
authors.initials: KM
authors.lastname: Nau
authors.forename: David A
authors.initials: DA
authors.lastname: Miller
authors.forename: Ricardo A
authors.initials: RA
authors.lastname: Hanel
authors.forename: Wd
authors.initials: W
authors.lastname: Freeman