Hypertonic Saline: Safe therapy for Children with Acute Brain Insult in Emergency Department of Low and Middle Income Country

Hypertonic saline (HTS) has been used for some years to treat elevated intracranial pressure in children in high income countries. There is limited safety data from low and middle income countries.

Objective: The primary objective of this study was to assess the immediate response and safety of intravenous administration of hypertonic saline in children with acute brain injury presenting to the pediatric emergency department (PED) of Aga Khan University Hospital (AKUH). The secondary outcomes were changes in outcome- predictive physiological parameters.

Methods: A retrospective, chart review of children who received intravenous HTS in the pediatric emergency department of AKU between January 2013 and December 2013 to treat acute brain injury (ABI). We studied both changes in physiological parameters and adverse effects related to HTS therapy.

Results: In the period studied, 216 children received intravenous bolus of 3% HTS as part of their initial management in the PED. The median age of the patients was 6.1 years (1 month to 16 years) and a median dose of 5 mL/kg with 98% of doses given via peripheral line between 30 minutes to one hour. Diagnosis included traumatic brain injury in 110 patients (50.9%) and non-traumatic injury 106 (49.1%) including CNS infection (43.4%), intracranial bleeding (7.5%), acute hepatic failure (10.4%), diabetic ketoacidosis with altered mental status (4.7%).

Clinical indications included: depressed consciousness (75.5%), seizures (24%) and shock (0.5%). Significant improvement was observed in both heart rate (p value < 0.05) and GCS (p value=0.001) after 3% HTS therapy No adverse events related to the HTS or its route of administration were noted in any child.

Conclusion: We found 3% HTS was safe in children with acute brain injury traumatic or non–traumatic brain injury.


Nadia Mohammad*, Surraiya Banu, Nick Brown, Sidra Kaleem, Saleem Akhtar, Anwar-ul-Haq

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