Hypertonic saline has been used for the treatment of hyponatremia for nearly a century. There is now general consensus that hypertonic saline should be used in patients with hyponatremia associated with moderate or severe symptoms to prevent neurological complications. However, much less agreement exists among experts regarding other aspects of its use. Should hypertonic saline be administered as a bolus injection or continuous infusion? What is the appropriate dose? Is a central venous line necessary? Should desmopressin be used concomitantly and for how long? This article considers these important questions, briefly explores the historical origins of hypertonic saline use for hyponatremia, and reviews recent evidence behind its indications, dosing, administration modality and route, combined use with desmopressin to prevent rapid correction of serum sodium, and other considerations such as the need and degree for fluid restriction. The authors conclude by offering some practical recommendations for the use of hypertonic saline.

高渗盐水用于治疗低钠血症已有近一个世纪的历史。目前普遍认为，伴有中度或重度症状的低钠血症患者应使用高渗盐水，以预防神经系统并发症。然而，专家们对其使用的其他方面的共识却少之又少。高渗盐水应该推注还是持续输注？合适的剂量是多少？中心静脉管有必要吗？去氨加压素是否应该同时使用以及持续多长时间？本文考虑了这些重要问题，简要探讨了高渗盐水治疗低钠血症的历史起源，并回顾了其适应症、剂量、给药方式和途径背后的最新证据，与去氨加压素联合使用，以防止血清钠的快速校正，以及其他考虑因素，例如液体限制的需要和程度。作者最后提出了一些关于使用高渗盐水的实用建议。