Saline therapy

In mild cases of hyponatremia, treatment typically focuses on water restriction (< 800 mL/day) however this approach suffers from poor patient compliance due to thirst brought on by increasing serum osmolality.1,10 In cases of extreme hyponatremia, infusions of hypertonic saline are used to elevate serum sodium concentrations. Loop diuretics (e.g., furosemide) are often used as an adjunct to such treatment to offset potential volume overload.1 Hypertonic saline therapy is also suboptimal, as it carries a risk of overly rapid adjustment of plasma sodium levels, which can result in the rapid shift of water from brain tissue to the vascular space, triggering neural demyelination that can result in seizures, coma, quadriplegia, and even death.1... 

Ciguatera. There are anecdotal reports of successful treatment with intravenous mannitol, 0.5-1 g/kg infused IV over 30 minutes. However, a recent randomized study showed no difference in outcome between mannitol and saline therapy. Gabapentin (400 mg TID) has also been reported to relieve symptoms. 

Intravenous 0.9% saline (if no contraindications are present) ° 200-300 mL/h initial therapy (patient-specific)... 

Nonpharmacologic management of thrombosis in a hemodialysis catheter involves saline flushes. Smaller clots may be managed by balloon angioplasty to mechanically open the catheter. In severe cases in whom clots cannot be removed by either mechanical or pharmacologic therapy, the catheter may require replacement. 

The tonicity of crystalloid solutions is directly related to their sodium concentration. The most commonly used crystalloids include normal saline, hypertonic saline, and lactated Ringer s solution. Excessive administration of any fluid replacement therapy, regardless of tonicity, can lead to fluid overload, particularly in patients with cardiac or renal insufficiency. 

When determining the appropriate fluid to be utilized, it is important to first determine the type of fluid problem (TBW versus ECF depletion), and start therapy accordingly. For patients demonstrating signs of impaired tissue perfusion, the immediate therapeutic goal is to increase the intravascular volume and restore tissue perfusion. The standard therapy is normal saline given at 150 to 500 mL/hour until perfusion is optimized. Although LR is a therapeutic alternative, lactic... 

Because the severity of symptoms and the absolute serum concentration are poorly correlated in some patients, institution of therapy should be dictated by the clinical scenario. All patients with hypercalcemia should be treated with aggressive rehydration normal saline at 200 to 300 mL/hour is a routine initial fluid prescription. For patients with mild hypocalcemia, hydration alone may provide adequate therapy. The moderate and severe forms of hypercalcemia are more likely to have significant manifestations and require prompt initiation of additional therapy. These patients may present with anorexia, confusion, and/or cardiac manifestations (bradycardia and arrhythmias with ECG changes). Total calcium concentrations greater than 13 mg/dL (3.25 mmol/L) are particularly worrisome, as these levels can unexpectedly precipitate acute renal failure, ventricular arrhythmias, and sudden death. 

Rest, fluids, humidified air, and nasal saline are the mainstays of nonpharmacologic therapy for the common cold. Pregnant women experiencing cold symptoms should be advised of these strategies and reminded that cold symptoms typically last only 7 to 10 days. 

Primary therapy is based on disease severity and type of hemorrhage.7 Most patients with mild to moderate disease and a minor bleeding episode can be treated with l-desamino-8-D-arginine vasopressin [desmopressin acetate (DDAVP)], a synthetic analog of the antidiuretic hormone vasopressin. DDAVP causes release of von Willebrand factor (vWF) and factor VIII from endogenous storage sites. This formulation increases plasma factor VIII levels by three- to fivefold within 30 minutes. The recommended dose is 0.3 mcg/kg intravenously (in 50 mL normal saline infused over 15 to 30 minutes) or subcutaneously or 300 meg intranasally via concentrated nasal spray every 12 hours. Peak effect with intranasal administration occurs 60 to 90 minutes after administration, which is somewhat later than with intravenous administration. Desmopressin infusion may be administered daily for up to 2 to 3 days. Tachyphylaxis, an attenuated response with repeated administration, may occur after several doses.8... 

Most patients with type 1 vWD (functionally normal vWF) and a minor bleeding episode can be treated successfully with desmopressin, which induces secretion of autologous factor VIII and vWF into plasma. The recommended dose is the same as that used to treat mild factor VIII deficiency (0.3 mcg/kg intravenously in 50 mL of normal saline infused over 15 to 30 minutes). This therapy generally is ineffective in type 2A patients who secrete qualitatively abnormal vWF and is controversial in type 2B patients because it may increase the risk of postinfusion thrombocytopenia. Type 3 vWD patients who lack releasable stores of vWF do not respond to DDAVP therapy.18... 

The patient was admitted to the hospital with a presumptive diagnosis of health care-associated pneumonia (based on the recent hospitalization). He received intravenous hydration with normal saline, 5 L oxygen via face mask, an insulin infusion to control his glucose, and empirical antimicrobial therapy with piperacillin-tazobactam 2.25 g intravenously every 6 hours and vancomycin 1 g intravenously every 24 hours. All other medications are continued with the exception of the diabetes medications. 

Ancillary treatments such as humidifiers, vaporizers, and saline nasal sprays or drops are used to moisturize the nasal canal and impair crusting of secretions along with promoting ciliary function. Although many patients report benefit from such therapies, there are no controlled studies that support their use.32,34,36... 

Calciuric therapy in the form of hydration is a key component of the treatment of hypercalcemia, regardless of severity or presence of symptoms.28 Mild or asymptomatic patients may be encouraged to increase oral fluid intake (3-4 L/day). Patients with moderate to severe or symptomatic hypercalcemia should receive normal saline at 200 to 500 mL/hour according to dehydration and cardiovascular status. Patients should be encouraged to ambulate as much as possible because immobility enhances... 

Calciuric therapy Intravenous normal saline 200-500 mlZhour 24-48 hours 2-3 days 0.5-2 mg/dL Avoid fluid overload, monitor electrolytes. 

The therapy for IRDS includes mechanical ventilation with continuous positive airway pressure. This maintains adequate ventilation and prevents airway collapse between breaths with the formation of atelectasis. Therapy also includes administration of exogenous pulmonary surfactant. Two types of surfactants are used to prevent and treat IRDS in the U.S. These include surfactants prepared from animal sources as well as synthetic surfactants. Exogenous pulmonary surfactants are administered as a suspension (in saline) through the endotracheal tube used for mechanical ventilation. 

Colloids (especially albumin) are expensive solutions, and a large study involving almost 7,000 critically ill patients found no significant difference in 28-day mortality between patients resuscitated with either normal saline or 4% albumin. For these reasons, crystalloids should be considered first-line therapy in patients with hypovolemic shock. 

Palliative and supportive measures are the cornerstone of therapy for patients with genital herpes. Pain and discomfort usually respond to warm saline baths or the use of analgesics, antipyretics, or antipruritics. 

Debridement can be accomplished by surgical or mechanical means (wet-to-dry dressing changes). Other effective therapies are hydrotherapy, wound irrigation, and dextranomers. Pressure sores should be cleaned with normal saline. 

Patients with hypervolemic hypotonic hyponatremia should be treated with 3% saline and prompt initiation of fluid restriction. Loop diuretic therapy will also likely be required to facilitate urinary excretion of free water. 

IV use should be limited to patients who have severe hypokalemia, signs and symptoms of hypokalemia, or inability to tolerate oral therapy. Potassium should be administered in saline because dextrose can stimulate... 

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