Use of hypertonic saline injection in trauma

Asad E. Patanwala, Albert Amini, Brian L. Erstad

Research output: Contribution to journalReview articlepeer-review

23 Scopus citations


Purpose. The use of hypertonic saline injection in trauma patients is discussed. Summary. Patients with hemorrhage, burns, and traumatic brain injury (TBI) may develop hypovolemic shock and require resuscitation. Compared with conventional isotonic crystalloids, hypertonic saline has several advantages, including hemodynamic, immune-modulating, and antiinflammatory effects, for use in trauma patients for resuscitation. In addition, hypertonic saline is also used in patients with TBI to reduce intracranial pressure (ICP). Overall, studies have not shown a difference in mortality or other clinically important outcomes with the use of hypertonic saline for resuscitation in trauma patients; however, most of these studies were not adequately powered to show significant differences. A recent Cochrane review concluded that there is no evidence that hypertonic crystalloids are better than isotonic or near-isotonic crystalloids for fluid resuscitation in trauma patients. Two recent trials that were adequately powered to investigate a mortality endpoint were halted for futility. A few small randomized controlled studies found that hypertonic saline was more effective than mannitol as a hyperosmolar agent for ICP reduction. Recent guidelines from the American Burn Association have suggested that hypertonic saline may be used for burn shock resuscitation by experienced providers with close monitoring to avoid excessive hypernatremia. One of the main concerns with the use of hypertonic saline is its potential to cause central pontine myelinolysis due to a rapid increase in serum sodium levels. Conclusion. There is no evidence that hypertonic saline provides any additional benefit over isotonic crystalloid solutions for trauma resuscitation. Hypertonic saline may be more effective than mannitol at reducing ICP in patients with TBI.

Original languageEnglish (US)
Pages (from-to)1920-1928
Number of pages9
JournalAmerican Journal of Health-System Pharmacy
Issue number22
StatePublished - Nov 15 2010


  • Brain injuries
  • Electrolytes
  • Mannitol
  • Osmotic agents
  • Protocols
  • Sodium chloride
  • Tonicity
  • Toxicity
  • Wounds and injuries

ASJC Scopus subject areas

  • Pharmacology
  • Health Policy


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