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Hypertonic saline (3% NaCl) therapy requires a delicate balance between effective treatment and avoiding complications. It is a crucial intervention in several neurological emergencies, such as impending brain herniation and symptomatic hyponatremia.
For impending brain herniation, the recommended dosage is 3 cc/kg administered over 3 minutes, with the option to repeat once. This rapid infusion aids in reducing intracranial pressure by creating an osmotic gradient, drawing fluid from the brain tissue into the intravascular space.
In cases of symptomatic hyponatremia, the treatment approach varies based on severity. Severe cases, characterized by seizures or coma, require 3 cc/kg over 10 minutes, potentially repeated once. For moderate cases presenting with altered mental status, headache, or vomiting, a slower infusion rate of 0.5 cc/kg/h is advised.
Careful monitoring is essential during hypertonic saline administration. Serum sodium levels should be checked every 1-4 hours. Treatment should be discontinued if serum sodium exceeds 120 mEq/L or if the rate of sodium increase surpasses 0.5 mEq/L/h. This precaution helps prevent osmotic demyelination syndrome, a severe complication of overly rapid sodium correction.