Page 158 - 2026 SMOG

HYPERTONIC SALINE 3% SODIUM CHLORIDE
Class
• Hypertonic crystalloid solution
Mechanism of Action
• Replaces water and electrolytes, reduces the amount of fluid in the cranial cavity, decreases
ICP, increases intravascular sodium concentration, and may induce diuresis.
Indications
• Refractory elevated intracranial pressure (ICP) due to various etiologies (e.g., subarachnoid
hemorrhage, neoplasm); traumatic brain injury with elevated ICP (can be used in place of
mannitol).
Contraindications
• Do not use in the same line as blood products—causes crenation and lysis of RBCs. Caution or
avoid use in patients with known congestive heart failure and kidney disease.
Adverse Reactions
• Rare
Drug Interactions
• Few in the pre-hospital emergency setting.
Dosage and Administration
• Dosing (Adult):
˚ Bolus: 250mL IV bolus over 10–20min
˚
Infusion: 50–100mL/hr
• Dosing (Pediatrics)
˚ Bolus: 6.5 to 10mL/kg IV bolus over 10–20min
˚
Infusion: 0.1 to 1mL/kg/hr titrated to the minimal rate required to maintain ICP <20mmHg
• It should be administered through a central line due to its high osmolarity and tonicity.

150 • MEDICATIONS