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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]
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).
Intravenous sodium bicarbonate is indicated in the treatment of metabolic acidosis, such as can occur in severe kidney disease, diabetic ketoacidosis [citation needed], circulatory insufficiency, extracorporeal circulation of blood, in hemolysis requiring alkalinization of the urine to avoid nephrotoxicity of blood pigments, and certain drug intoxications, such as by barbiturate overdose ...
Side effects may include vomiting, high blood sodium, or high blood potassium. [1] If vomiting occurs, it is recommended that use be paused for 10 minutes and then gradually restarted. [1] The recommended formulation includes sodium chloride, sodium citrate, potassium chloride, and glucose. [1]
Severe hyponatremia or severe symptoms (confusion, convulsions, or coma): consider hypertonic saline (3%) 1–2 mL/kg IV in 3–4 h. Hypertonic saline may lead to a rapid dilute diuresis and fall in the serum sodium. It should not be used in those with an expanded extracellular fluid volume.
Mannitol is a type of sugar alcohol used as a sweetener and medication. [5] [6] It is used as a low calorie sweetener as it is poorly absorbed by the intestines. [5]As a medication, it is used to decrease pressure in the eyes, as in glaucoma, and to lower increased intracranial pressure.
If the sodium level is <120 mEq/L, the person can be treated with hypertonic saline as extremely low levels are associated with severe neurological symptoms. [14] In non-emergent situations, it is important to correct the sodium slowly to minimize risk of osmotic demyelination syndrome.
Side effects may include irritation of the vein in which it is given, high blood sugar, and swelling. [2] [3] Excess use may result in low blood sodium and other electrolyte problems. [2] Intravenous sugar solutions are in the crystalloid family of medications. [4] They come in a number of strengths including 5%, 10%, and 50% dextrose. [2]