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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]
Hypertonic saline and mannitol are the main osmotic agents in use, while loop diuretics can aid in the removal of the excess fluid pulled out of the brain. [1] [3] [7] [43] Hypertonic saline is a highly concentrated solution of sodium chloride in water and is administered intravenously. [3]
Hypertonic saline can improve ICP by reducing the amount of cerebral water (swelling), though it is used with caution to avoid electrolyte imbalances or heart failure. [ 10 ] [ 100 ] [ 101 ] Mannitol , an osmotic diuretic , [ 10 ] appears to be as effective as hypertonic saline at reducing ICP; [ 102 ] [ 103 ] [ 100 ] [ 104 ] however, some ...
Treatments may involve controlling elevated intracranial pressure. This can include sedation, paralytics, cerebrospinal fluid diversion. Second-line alternatives include decompressive craniectomy (Jagannathan et al. found a net 65% favorable outcomes rate in pediatric patients), barbiturate coma, hypertonic saline, and hypothermia.
If there is an intact blood–brain barrier, osmotherapy (mannitol or hypertonic saline) may be used to decrease ICP. [33] It is unclear whether mannitol or hypertonic saline is superior, or if they improve outcomes. [34] [35] Struggling, restlessness, and seizures can increase metabolic demands and oxygen consumption, as well as increasing ...
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).
A recent paper reports that the use of the drug tenecteplase, not yet approved for stroke treatment in the U.S., may lead to slightly better outcomes after a stroke than the commonly used alteplase.
[2] total of 8 mmol per liter during the first day with the use of furosemide and replacing sodium and potassium losses with 0.9% saline. For people with severe symptoms (severe confusion, convulsions, or coma) hypertonic saline (3%) 1–2 ml/kg IV in 3–4 h may be given. [2]
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