title: Safety and efficacy of intravenous hypotonic 0.225% sodium chloride infusion for the treatment of hypernatremia in critically ill patients.
abstract: BACKGROUND
  The purpose of this study was to evaluate the safety and efficacy of central venous administration of a hypotonic 0.225% sodium chloride (one-quarter normal saline [¼ NS]) infusion for critically ill patients with hypernatremia.
  
  
  METHODS
  Critically ill, adult patients with traumatic injuries and hypernatremia (serum sodium [Na] >150 mEq/L) who were given ¼ NS were retrospectively studied. Serum sodium, fluid balance, free water intake, sodium intake, and plasma free hemoglobin concentration (fHgb) were assessed.
  
  
  RESULTS
  Twenty patients (age, 50 ± 18 years; Injury Severity Score, 29 ± 12) were evaluated. The ¼ NS infusion was given at 1.5 ± 1.0 L/d for 4.6 ± 1.6 days. Serum sodium concentration decreased from 156 ± 4 to 143 ± 6 mEq/L (P < .001) over 3-7 days. Total sodium intake was decreased from 210 ± 153 to 156 ± 112 mEq/d (P < .05). Daily net fluid balance was not significantly increased. Plasma fHgb increased from 4.9 ± 5.4 mg/dL preinfusion to 8.9 ± 7.4 mg/dL after 2.6 ± 1.3 days of continuous intravenous (IV) ¼ NS in 10 patients (P = .055). An additional 10 patients had a plasma fHgb of 10.2 ± 9.0 mg/dL during the infusion. Hematocrit and hemoglobin decreased (26% ± 3% to 24% ± 2%, P < .001 and 9.1 ± 1.1 to 8.2 ± 0.8 g/dL, P < .001, respectively).
  
  
  CONCLUSIONS
  Although IV ¼ NS was effective for decreasing serum sodium concentration, evidence for minor hemolysis warrants further research to establish its safety before its routine use can be recommended.
authors.affiliation: Department of Clinical Pharmacy, University of Tennessee Health Science Center, Memphis, TN 38163, USA. rdickerson@uthsc.edu
authors.forename: Roland N
authors.initials: RN
authors.lastname: Dickerson
authors.forename: George O
authors.initials: GO
authors.lastname: Maish
authors.forename: Jordan A
authors.initials: JA
authors.lastname: Weinberg
authors.forename: Martin A
authors.initials: MA
authors.lastname: Croce
authors.forename: Gayle
authors.initials: G
authors.lastname: Minard
authors.forename: Rex O
authors.initials: RO
authors.lastname: Brown
mesh_terms: D000328:Adult; D000368:Aged; D016638:Critical Illness; D005260:Female; D006400:Hematocrit; D006454:Hemoglobins / Q000032:analysis; D006801:Humans; D006955:Hypernatremia / Q000188:drug therapy*; D007262:Infusions, Intravenous; D007362:Intensive Care Units; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D018529:Nutritional Support; D012189:Retrospective Studies; D012964:Sodium / Q000097:blood; D012965:Sodium Chloride / Q000008:administration & dosage* / Q000097:blood; D014882:Water-Electrolyte Balance
chemical_list: D006454:Hemoglobins; D012965:Sodium Chloride; D012964:Sodium
keywords: critical care; hemolysis; hypernatremia; sodium; water-electrolyte balance