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Hypertonic Saline Buffered with Sodium Acetate for Intracranial Pressure Management
Clinical Neurology and Neurosurgery ( IF 1.9 ) Pub Date : 2021-02-01 , DOI: 10.1016/j.clineuro.2020.106435
Devin N Holden 1 , Francine H Yung 2 , Pouya Entezami 1
Affiliation  

BACKGROUND 3 % hypertonic saline (HS) is a hyperosmolar agent often used to treat elevated intracranial pressure (ICP). However, the resultant hyperchloremia is associated with adverse outcomes in certain patient populations. In this study, HS solution buffered with sodium acetate (HSwSA) is used as an alternative to standard 3 % formulations to reduce overall chloride exposure. Our objectives are to establish whether this alternative agent - with reduced chloride content - is similar to standard 3 % HS in maintaining hyperosmolarity and investigate its effects on hyperchloremia. METHODS A retrospective chart review was conducted from August 1, 2014 to August 1, 2017 on patients receiving hypertonic therapies for ICP management. Patients were categorized into three groups, those that received: (1) 3 % HS for at least 72 h, (2) HSwSA for at least 72 h, or (3) were switched from 3 % HS within 72 h of initiating therapy to HSwSA for at least 72 h. RESULTS The average increase in serum osmolality after 72 h of therapy was 21.1 moSm/kg for those only on 3 % HS and 20.3 mOsm/kg for those only on HSwSA. Serum chloride levels after 24 h decreased on average by 2.5 mEq/L after switching from 3% HS to HSwSA and stayed below baseline, whereas matched patients only receiving 3% HS on average had serum chloride levels increase 4.3 mEq/L after 24 h and continued to rise. CONCLUSIONS Hyperchloremia has been associated with decreased renal perfusion, increasing the risk of acute kidney injury and hyperchloremic metabolic acidosis. Compared to standard 3% HS, our findings suggest an alternative hyperosmolar therapy with less chloride maintains similar hyperosmolarity while reducing overall chloride exposure.

中文翻译:

用醋酸钠缓冲的高渗盐水用于颅内压管理

背景 3% 高渗盐水 (HS) 是一种高渗剂,常用于治疗颅内压升高 (ICP)。然而,由此产生的高氯血症与某些患者群体的不良结果有关。在本研究中,使用醋酸钠 (HSwSA) 缓冲的 HS 溶液作为标准 3% 配方的替代品,以减少总体氯化物暴露。我们的目标是确定这种具有降低氯化物含量的替代药物在维持高渗透压方面是否与标准的 3% HS 相似,并研究其对高氯血症的影响。方法 对 2014 年 8 月 1 日至 2017 年 8 月 1 日期间接受高渗疗法进行 ICP 管理的患者进行回顾性图表审查。患者被分为三组,那些接受:(1) 3 % HS 至少 72 小时,(2) HSwSA 至少 72 小时,或 (3) 在开始治疗的 72 小时内从 3% HS 转换为 HSwSA 至少 72 小时。结果 治疗 72 小时后血清渗透压的平均增加对于仅使用 3% HS 的患者为 21.1 moSm/kg,对于仅使用 HSwSA 的患者为 20.3 mOsm/kg。从 3% HS 切换到 HSwSA 后,24 小时后血清氯化物水平平均下降 2.5 mEq/L 并保持在基线以下,而仅接受 3% HS 的匹配患者在 24 小时后血清氯化物水平增加 4.3 mEq/L,并且继续上涨。结论 高氯血症与肾灌注减少有关,增加了急性肾损伤和高氯代谢性酸中毒的风险。与标准的 3% HS 相比,
更新日期:2021-02-01
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