Safety and efficacy of intravenous hypotonic 0.225% sodium chloride infusion for the treatment of hypernatremia in critically ill patients

Roland Dickerson, George O. Maish, Jordan A. Weinberg, Martin Croce, Gayle Minard, Rex Brown

Research output: Contribution to journalArticle

4 Citations (Scopus)

Abstract

Background: The purpose of this study was to evaluate the safety and efficacy of central venous administration of a hypotonic 0.225% sodium chloride (one-quarter normal saline [1/4 NS]) infusion for critically ill patients with hypernatremia. Methods: Critically ill, adult patients with traumatic injuries and hypernatremia (serum sodium [Na] >150 mEq/L) who were given 1/4 NS were retrospectively studied. Serum sodium, fluid balance, free water intake, sodium intake, and plasma free hemoglobin concentration (fHgb) were assessed. Results: Twenty patients (age, 50 ± 18 years; Injury Severity Score, 29 ± 12) were evaluated. The 1/4 NS infusion was given at 1.5 ± 1.0 L/d for 4.6 ± 1.6 days. Serum sodium concentration decreased from 156 ± 4 to 143 ± 6 mEq/L (P <.001) over 3-7 days. Total sodium intake was decreased from 210 ± 153 to 156 ± 112 mEq/d (P <.05). Daily net fluid balance was not significantly increased. Plasma fHgb increased from 4.9 ± 5.4 mg/dL preinfusion to 8.9 ± 7.4 mg/dL after 2.6 ± 1.3 days of continuous intravenous (IV) 1/4 NS in 10 patients (P =.055). An additional 10 patients had a plasma fHgb of 10.2 ± 9.0 mg/dL during the infusion. Hematocrit and hemoglobin decreased (26% ± 3% to 24% ± 2%, P <.001 and 9.1 ± 1.1 to 8.2 ± 0.8 g/dL, P <.001, respectively). Conclusions: Although IV 1/4 NS was effective for decreasing serum sodium concentration, evidence for minor hemolysis warrants further research to establish its safety before its routine use can be recommended.

Original languageEnglish (US)
Pages (from-to)400-408
Number of pages9
JournalNutrition in Clinical Practice
Volume28
Issue number3
DOIs
StatePublished - Jun 1 2013

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Hypernatremia
Critical Illness
Sodium Chloride
Sodium
Safety
Hemoglobins
Water-Electrolyte Balance
Serum
Therapeutics
Injury Severity Score
Hemolysis
Hematocrit
Drinking
4-(2-(4-isopropylbenzamido)ethoxy)benzoic acid
Wounds and Injuries
Research

All Science Journal Classification (ASJC) codes

  • Medicine (miscellaneous)
  • Nutrition and Dietetics

Cite this

Safety and efficacy of intravenous hypotonic 0.225% sodium chloride infusion for the treatment of hypernatremia in critically ill patients. / Dickerson, Roland; Maish, George O.; Weinberg, Jordan A.; Croce, Martin; Minard, Gayle; Brown, Rex.

In: Nutrition in Clinical Practice, Vol. 28, No. 3, 01.06.2013, p. 400-408.

Research output: Contribution to journalArticle

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title = "Safety and efficacy of intravenous hypotonic 0.225{\%} sodium chloride infusion for the treatment of hypernatremia in critically ill patients",
abstract = "Background: The purpose of this study was to evaluate the safety and efficacy of central venous administration of a hypotonic 0.225{\%} sodium chloride (one-quarter normal saline [1/4 NS]) infusion for critically ill patients with hypernatremia. Methods: Critically ill, adult patients with traumatic injuries and hypernatremia (serum sodium [Na] >150 mEq/L) who were given 1/4 NS were retrospectively studied. Serum sodium, fluid balance, free water intake, sodium intake, and plasma free hemoglobin concentration (fHgb) were assessed. Results: Twenty patients (age, 50 ± 18 years; Injury Severity Score, 29 ± 12) were evaluated. The 1/4 NS infusion was given at 1.5 ± 1.0 L/d for 4.6 ± 1.6 days. Serum sodium concentration decreased from 156 ± 4 to 143 ± 6 mEq/L (P <.001) over 3-7 days. Total sodium intake was decreased from 210 ± 153 to 156 ± 112 mEq/d (P <.05). Daily net fluid balance was not significantly increased. Plasma fHgb increased from 4.9 ± 5.4 mg/dL preinfusion to 8.9 ± 7.4 mg/dL after 2.6 ± 1.3 days of continuous intravenous (IV) 1/4 NS in 10 patients (P =.055). An additional 10 patients had a plasma fHgb of 10.2 ± 9.0 mg/dL during the infusion. Hematocrit and hemoglobin decreased (26{\%} ± 3{\%} to 24{\%} ± 2{\%}, P <.001 and 9.1 ± 1.1 to 8.2 ± 0.8 g/dL, P <.001, respectively). Conclusions: Although IV 1/4 NS was effective for decreasing serum sodium concentration, evidence for minor hemolysis warrants further research to establish its safety before its routine use can be recommended.",
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AB - Background: The purpose of this study was to evaluate the safety and efficacy of central venous administration of a hypotonic 0.225% sodium chloride (one-quarter normal saline [1/4 NS]) infusion for critically ill patients with hypernatremia. Methods: Critically ill, adult patients with traumatic injuries and hypernatremia (serum sodium [Na] >150 mEq/L) who were given 1/4 NS were retrospectively studied. Serum sodium, fluid balance, free water intake, sodium intake, and plasma free hemoglobin concentration (fHgb) were assessed. Results: Twenty patients (age, 50 ± 18 years; Injury Severity Score, 29 ± 12) were evaluated. The 1/4 NS infusion was given at 1.5 ± 1.0 L/d for 4.6 ± 1.6 days. Serum sodium concentration decreased from 156 ± 4 to 143 ± 6 mEq/L (P <.001) over 3-7 days. Total sodium intake was decreased from 210 ± 153 to 156 ± 112 mEq/d (P <.05). Daily net fluid balance was not significantly increased. Plasma fHgb increased from 4.9 ± 5.4 mg/dL preinfusion to 8.9 ± 7.4 mg/dL after 2.6 ± 1.3 days of continuous intravenous (IV) 1/4 NS in 10 patients (P =.055). An additional 10 patients had a plasma fHgb of 10.2 ± 9.0 mg/dL during the infusion. Hematocrit and hemoglobin decreased (26% ± 3% to 24% ± 2%, P <.001 and 9.1 ± 1.1 to 8.2 ± 0.8 g/dL, P <.001, respectively). Conclusions: Although IV 1/4 NS was effective for decreasing serum sodium concentration, evidence for minor hemolysis warrants further research to establish its safety before its routine use can be recommended.

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