Hypertonic saline solution

Qureshi A, Suarez JI. Use of hypertonic saline solutions in treatment of cerebral edema and intracranial hypertension. Crit Care Med 2000 28(9) 3301-3313. 

Over the years it has been interesting to note that many compounded products eventually become commercially available products. Recent examples might include fentanyl lozenges, minoxidil topical solution, nystatin lozenges, clindamycin topical solution, tetracaine-adrenalin-cocaine (TAG) solution, dihydroergotamine mesylate nasal spray, buprenorphine nasal spray, buffered hypertonic saline solution, and erythromycin topical solution as well as numerous other dermatological and pediatric oral liquids and some... 

Rabinovici R, Rudolph A8, Vernick J, et al. A new salutary resuscitative fluid liposome encapsulated hemoglobin/hypertonic saline solution. J Trauma 1993 35 121. 

Gastric lavage (with hypertonic saline solution, apomorphine injection for ingested poison). 

Despite their apparent efficacy, the usefulness of sodium chloride solutions in the treatment of edematous corneas with a traumatized epithelium appears to be limited. The intact corneal epithelium exhibits limited permeability to inorganic ions. In the absence of an intact epithelium the cornea imbibes salt solutions, which reduces the osmotic effect. In the management of corneal edema associated with traumatized epithelium, hypertonic saline solutions may be of limited value due to their increased ability to penetrate the epithelial barrier. 

Paterna S, Di Pasquale P, Parrinello G, Amato P, Cardinale A, Follone G, GiubUato A, Licata G. Effects of high-dose furosemide and smaU-volume hypertonic saline solution infusion in comparison with a high dose of furosemide as a bolus, in refractory congestive heart failure. Eur J Heart Fail 2000 2(3) 305-313. 

New research in human patients suggests a role for moderately hypertonic saline solutions (1.6-3%) in children with head injuries (Khanna et al 2000, Peterson et al 2000, Simma et al 1998). Whether this might also be useful in head injury or hypoxic ischemic encephalopathy in neonatal foals remains to be evaluated. 

Krausz M M, Ravid A, Izhar U et al 1993 The effect of heat load and dehydration on hypertonic saline solution treatment of controlled hemorrhagic shock. Surgery, Gynecology and Cbstetrlcs 177 583-592 Krumbhaar E B 1914 Hemolysis due to intravenous injection of distilled water. Journal of the American Medical Association 62 992-993... 

McCabe JL, Cobaugh DJ, Menegazzi JJ, and Fata J (1998) Experimental tricyclic antidepressant toxicity A randomized, controlled comparison of hypertonic saline solution, sodium bicarbonate and hyperventilation. Annals of Emergency Medicine 32 329-333. 

Administer hypertonic saline solution IV such as 3% NaCl to restore the serum sodium level. 

By causing redistribution (i.e., pulling fluid) from the intracellular space, hypertonic solutions cause rapid expansion of the intravascular compartment, which is essential for vital organ perfusion. In head-injured patients, this redistribution should decrease intracranial pressure because the vessels of the brain are more impermeable to sodium ions than vessels in other areas of the body. Additionally, hypertonic saline solutions have beneficial immunomodulating actions when compared with more isotonic solutions in experiments with animals. ... 

Unfortunately, beneficial outcome data attributable to administration of these hypertonic solutions also have been lacking. Most of these studies were conducted in prehospital and emergency department settings using 250 mL 7.5% sodium chloride with or without 6% dextran-70. A meta-analysis of randomized, controlled trials found no statistical difference between the survival rates of patients receiving the hypertonic saline solutions and those receiving standard isotonic crystalloid solutions.Part of the explanation for this finding may... 

It is well known that hypertonic saline solution utilized intra-amniotically can produce hypercoagulability of the blood. It is less well known that very high doses of heparin (12 mg/hr) are needed to prevent such disorders (7 =). 

Hypertonic sahne is actively excluded from an intact BBB and also acts to draw water into the intravascular space by the creation of a sodium gradient. Various concentrations have been evaluated, with continuous sodium chloride infusions ranging from 3% to 9%, and bolus infusions up to 23.4% administered over 20 minutes in a 30 mL solution. When a continuous infusion is used, the serum sodium is typically titrated to the 155-160 range. Sodium levels above this range raise the concern for seizures and other toxic side effects. Hypertonic saline may hold an advantage over mannitol, as it has been found in animal models to decrease edema in both... 

Schwarz S, Schwab S, Bertram M, Aschoff A, Hacke W. Effects of hypertonic saline hydroxyethyl starch solution and mannitol in patients with increased intracranial pressure after stroke. Stroke 1998 29(8) 1550-1555. 

Therapeutic fluids include crystalloid and colloid solutions. The most commonly used crystalloids include normal saline, hypertonic saline, and lactated Ringer s solution. Examples of colloids include albumin, the dextrans, hetastarch, and fresh frozen plasma. 

Fluids can be classified further according to their tonicity. Isotonic solutions (i.e., normal saline or 0.9% sodium chloride [NaCl]) have a tonicity equal to that of the ICF (approximately 310 mEq/L or 310 mmol/L) and do not shift the distribution of water between the ECF and the ICF. Because hypertonic solutions (i.e., hypertonic saline or 3% NaCl) have greater tonicity than the ICF (greater than 376 mEq/L or 376 mmol/L), they draw water from the ICF into the ECF. In contrast, hypotonic solutions (i.e., 0.45% NaCl) have less tonicity than the ICF (less than 250 mEq/L or 250 mmol/L) leading to an osmotic pressure gradient that pulls water from the ECF into the ICF. The tonicity, electrolyte content, and glucose content of selected fluids are shown in Table 24—3. 

Hypertonic saline is obviously hypertonic and provides a significant sodium load to the intravascular space. This solution is utilized very infrequently given the potential to cause significant shifts in the water balance between the ECF and the ICF. It is typically considered to treat patients with severe hyponatremia who have symptoms attributable to low serum sodium. 

Living cells, among them the red blood cells, are surrounded by semipermeable membranes. The osmolarity of most cells is 0.30 osmol. For example, a 0.89% w/v NaCl solution, normally referred to as physiological saline solution, has an osmolarity of 0.30. Thus when a cell is put in physiological saline solution, the osmolarity on both sides of the membrane is the same and therefore no osmotic pressure is generated across the membrane. Such a solution is called isotonic. On the other hand, if a cell is put in water (pure solvent) or in a solution which has lower osmolarity than the cell, there will be a net flow of water into the cell driven by the osmotic pressure. Such a solution is called hypotonic. A cell placed in a hypotonic solution will swell and eventually may burst. If that happens to a red blood cell, the process is called hemolysis. In contrast, a solution with higher osmolarity than the cell is called a hypertonic solution. A cell suspended in a hypertonic solution will shrivel there is a net flow of water from the cell into the surroundings. When that happens to a red blood cell, the process is called crenation. 

The osmolarity of a physiological saline solution is 0.30 osmol. Is a 0.30 M MgCl2 solution isotonic, hypotonic, or hypertonic with the physiological saline ... 

These observations have several important practical implications. First, hospitals must store red blood cells in a plasma solution which has the correct proportions of salts and proteins. The plasma solution is made to be slightly hypertonic to the red cells so that the integrity of the cells is preserved and hemolysis is prevented. Second, when doctors inject a drug intravenously into a patient, the drug is suspended in a saline solution which is slightly hypertonic to red blood cells. Intravenous injection of a drug in pure water will cause some of the patient s red blood cells to hemolyze because water is hypotonic to the red blood cells. 

However, in the horse, the administration of a highly concentrated formula of hypertonic saline-dextran 70 resulted in clinically apparent intravascular hemolysis and hemoglobinuria (Moon et al 1991). Whether less-concentrated formulas are suitable for the horse remains to be investigated. The combination of an alternative colloid, hetastarch (lOml/kg), and hypertonic saline (4 ml/kg) may be an appropriate solution for the resuscitation of horses that are both hypovolemic and dehydrated. Clinical experience suggests that hypertonic-saline-hetastarch is particularly useful in horses with marked hypovolemia and hypoproteinemia, such as those with severe colitis, but this has not been formally evaluated in experimental studies or clinical cases. 

Constable P D, Gohar H M, Morin D E et al 1996 Use of hypertonic saline-dextran solution to resuscitate hypovolemic calves with diarrhea. American Journal of Veterinary Research 57 97-104 Constable P D, Hinchcliff K W, Muir W W 1998 Comparison of anion gap and strong ion gap as predictors of unmeasured strong ion concentration in plasma and serum from horses. American Journai of Veterinary Research 59 881-887... 

Simma B, Burger R, Falk M et al 1998 A prospective, randomized, and controlled study of fluid management in children with severe head injury lactated Ringer s solution versus hypertonic saline. Critical Care Medicine 26 1265-1270... 

Attempts at lengthening intravascular resident time of the solution and limit third spacing have resulted in the development of hypertonic crystalloid solutions. An example of a hypertonic solution is 3% NaCI ( hypertonic saline ). It has been suggested that the increased electrolyte... 

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