Repeated Dosing of 23.4% Hypertonic Saline for Refractory Intracranial Hypertension. A Case Report

Abstract

Background: Hypertonic saline (HTS) at a concentration of 23.4% is an emerging therapy for intracranial hypertension. Compared to
mannitol which can be given as a single bolus or as repeated bolus dosing, little data exists regarding safety or efficacy of repeated
dosing of 23.4% HTS. We report the first case of 16 doses of 23.4% HTS over a 5 day period in a patient with refractory intracranial
hypertension.
Case Report: A 43-year-old woman with Fisher 3 subarachnoid hemorrhage and hydrocephalus requiring an external ventricular drain
developed global cerebral edema on computed tomography. Medically refractory intracranial hypertension ensued which required
repeated dosing of 23.4% HTS. Reductions in intracranial pressure (ICP) occurred after each dose of 23.4% HTS. No central nervous
system complications occurred. Anasarca was the only observed complication, which responded to furosemide diuresis.

Conclusion: Repeated dosing of 23.4% HTS was effective in reducing ICP in a case of medically refractory intracranial hypertension
without major systemic complications. Prospective studies should address the safety and efficacy of repeat dose 23.4% HTS on serum
sodium, intracranial pressure, and complications.