title: Hypertonic saline solution reduces the oxidative stress responses in traumatic brain injury patients.
abstract: BACKGROUND
  Oxidative stress processes play an important role in the pathogenesis of secondary brain injury after traumatic brain injury (TBI). Hypertonic saline (HTS) has advantages as being preferred osmotic agent, but few studies investigated oxidant and antioxidant effects of HTS in TBI. This study was designed to compare two different regimens of HTS 5% with mannitol on TBI-induced oxidative stress.
  
  
  METHODS
  Thirty-three adult patients with TBI were recruited and have randomly received one of the three protocols: 125 cc of HTS 5% every 6 h as bolus, 500 cc of HTS 5%as infusion for 24 h or 1 g/kg mannitol of 20% as a bolus, repeated with a dose of 0.25-0.5 g/kg every 6 h based on patient's response for 3 days. Serum total antioxidant power (TAP), reactive oxygen species (ROS) and nitric oxide (NO) were measured at baseline and daily for 3 days.
  
  
  RESULTS
  Initial serum ROS and NO levels in patients were higher than control(6.86± [3.2] vs. 1.57± [0.5] picoM, P = 0.001, 14.6± [1.6] vs. 7.8± [3.9] mM, P = 0.001, respectively). Levels of ROS have decreased for all patients, but reduction was significantly after HTS infusion and mannitol (3. 08 [±3.1] to 1.07 [±1.6], P = 0.001, 5.6 [±3.4] to 2.5 [±1.8], P = 0.003 respectively). During study, NO levels significantly decreased in HTS infusion but significantly increased in mannitol. TAP Levels had decreased in all patients during study especially in mannitol (P = 0.004).
  
  
  CONCLUSIONS
  Hypertonic saline 5% has significant effects on the oxidant responses compared to mannitol following TBI that makes HTS as a perfect therapeutic intervention for reducing unfavorable outcomes in TBI patients.
authors.affiliation: Department of Pharmacotherapy, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran.
authors.forename: Mojtaba
authors.initials: M
authors.lastname: Mojtahedzadeh
authors.affiliation: Department of Anesthesiology and Intensive Care, School of Medicine, Tehran University of Medical Science and Health Services, Tehran, Iran.
authors.forename: Arezoo
authors.initials: A
authors.lastname: Ahmadi
authors.affiliation: Department of Anesthesiology and Intensive Care, School of Medicine, Tabriz University of Medical Science and Health Services, Tabriz, Iran.
authors.forename: Ata
authors.initials: A
authors.lastname: Mahmoodpoor
authors.affiliation: Department of Anesthesiology and Intensive Care, School of Medicine, Tehran University of Medical Science and Health Services, Tehran, Iran.
authors.forename: Mohammad Taghi
authors.initials: MT
authors.lastname: Beigmohammadi
authors.affiliation: Laboratory of Toxicology, Department of Toxicology and Pharmacology, Faculty of Pharmacy, and Pharmaceutical Sciences Research Center, Tehran University of Medical Sciences, Tehran, Iran.
authors.forename: Mohammad
authors.initials: M
authors.lastname: Abdollahi
authors.affiliation: Brain and Spinal Injury Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran.
authors.forename: Zahra
authors.initials: Z
authors.lastname: Khazaeipour
authors.affiliation: Department of Toxicology and Pharmacology, Mazandaran University of Medical Sciences, Sari, Iran.
authors.forename: Fatemeh
authors.initials: F
authors.lastname: Shaki
authors.affiliation: Department of Pharmacotherapy, Faculty of Pharmacy, Mazandaran University of Medical Science and Health Services, Sari, Iran.
authors.forename: Bizhan
authors.initials: B
authors.lastname: Kuochaki
authors.affiliation: Department of Pharmacotherapy, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran ; Department of Pharmacotherapy, Faculty of Pharmacy, Mazandaran University of Medical Science and Health Services, Sari, Iran.
authors.forename: Narjes
authors.initials: N
authors.lastname: Hendouei
keywords: Hypertonic saline; mannitol; oxidative stress response; traumatic brain injury patients