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Saline solution for irrigation. Normal saline (NSS, NS or N/S) is the commonly used phrase for a solution of 0.90% w/v of NaCl, 308 mOsm/L or 9.0 g per liter. Less commonly, this solution is referred to as physiological saline or isotonic saline (because it is approximately isotonic to blood serum, which makes it a physiologically normal solution).
The presence of cerebral edema, or other moderate to severe symptoms, may necessitate intravenous hypertonic saline administration with close monitoring of the serum sodium levels to avoid overcorrection. [2] SIADH was originally described in 1957 in two people with small-cell carcinoma of the lung. [3]
Hypertonic Saline which contains sodium chloride works in regulating ICP, intravascular volume and cardiac output without causing significant diuresis, but there are theoretical side effects ranging from neurological complications to subdural hematoma. Hypertonic saline solution has been choice of neuro critical care for the past few years. [1]
A bolus intravenous dose of 10 or 20 mg of furosemide can be administered and then followed by intravenous bolus of 2 or 3% hypertonic saline to increase the serum sodium level. [ 12 ] Pulmonary edema - Slow intravenous bolus dose of 40 to 80 mg furosemide at 4 mg per minute is indicated for patients with fluid overload and pulmonary edema.
Generally, 100 mL of hypertonic saline given as a bolus will increase the serum sodium 2-3 mEq/L. Concurrently the slow administration of intravenous diuretics such as furosemide can correct the sodium by diuresis, however these should be given with caution as they may paradoxically cause a reduction in serum sodium concentration.
Additionally, crystalloids have an acidic pH, and the administration of large quantities of isotonic or slightly hypertonic crystalloid solutions such as 0.9% normal saline or Lactated Ringer's can cause or aggravate metabolic acidosis, another component of the "Triad of Death" leading to a decrease in myocardial (heart muscle) function.
Guidelines recommend against the use of nebulized hypertonic saline in the emergency department for children with bronchiolitis but it may be given to children who are hospitalized. [9] [15] Nebulized hypertonic saline (3%) has limited evidence of benefit and previous studies lack consistency and standardization.
Data from one study suggests that immediate administration of 100 mL intravenous bolus of 3% hypertonic saline was more effective at normalizing blood sodium levels than oral administration for asymptomatic EAH. [17]