Authors: Karen G Hirsch Todd Spock Matthew A Koenig Romergryko G Geocadin
Publish Date: 2012/02/11
Volume: 17, Issue: 3, Pages: 388-394
Abstract
The primary outcome measure was reversal of TTH or ICP crisis Secondary outcome measures were modified Rankin scale on hospital discharge survival to hospital discharge and adverse effects Of 254 subjects over 7 years 6 patients with endstage renal disease had 11 events All patients received a 234 saline bolus along with mannitol 91 hypertonic saline HS maintenance fluids 82 and surgical interventions n = 2 Reversal occurred in 6/11 events 55 2 of 6 patients survived to discharge ICP recording of 6 TTH events showed a reduction from ICP of 41 ± 38 mmHg mean ± SEM with TTH to 208 ± 39 mmHg p = 005 1 h after the 234 saline bolus Serum sodium increased from 1414 to 1511 mmol/L 24 h after 234 saline bolus p = 0001 No patients were undergoing hemodialysis at the time of the event There were no cases of pulmonary edema clinical volume overload or arrhythmia after HSTreatment with hyperosmolar therapy primarily 234 saline solution was associated with clinical reversal of TTH and reduction in ICP and had few adverse effects in this cohort Hyperosmolar therapy may be safe and effective in patients with renal failure and these initial findings should be validated in a prospective study
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