Administration of hypertonic (3%) sodium chloride/acetate in hyponatremic patients with symptomatic vasospasm following subarachnoid hemorrhage

J Neurosurg Anesthesiol. 1999 Jul;11(3):178-84. doi: 10.1097/00008506-199907000-00004.


A retrospective study was carried out to evaluate the effect of hypertonic (3%) saline chloride/acetate on various hemodynamic parameters in mildly hyponatremic patients with symptomatic vasospasm following aneurysmal subarachnoid hemorrhage (SAH). We identified 29 hyponatremic (serum sodium < 135 mEq/L) patients who received hypertonic (3%) sodium chloride/acetate as a continuous infusion. Administration of hypertonic (3%) sodium chloride/acetate resulted in higher central venous pressures and positive fluid balance, with a concomitant increase in serum sodium and chloride concentrations without metabolic acidosis. There were no changes in mean cerebral blood flow velocities after infusion of hypertonic (3%) sodium chloride/acetate. We found no reports of congestive heart failure, pulmonary edema, metabolic acidosis, coagulopathy, intracranial hemorrhages, or central pontine myelinolysis in any of these patients. We conclude that hypertonic (3%) sodium chloride/acetate can be administered to patients with mild hyponatremia in the setting of symptomatic vasospasm following SAH without untoward effects. Sample size and limitations of a retrospective analysis preclude conclusions about safety and efficacy of hypertonic (3%) sodium chloride/acetate administration in this patient population. However, our results support justification for a prospective, randomized, double-blind trial of hypertonic (3%) sodium chloride/acetate versus normal saline in patients with symptomatic vasospasm following SAH.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Acetates / administration & dosage
  • Acetates / therapeutic use*
  • Analysis of Variance
  • Blood Flow Velocity / drug effects
  • Central Venous Pressure / drug effects
  • Cerebrovascular Circulation / drug effects
  • Chlorides / blood
  • Coronary Vasospasm / diagnostic imaging
  • Coronary Vasospasm / etiology*
  • Double-Blind Method
  • Female
  • Hemodynamics / drug effects
  • Humans
  • Hyponatremia / blood
  • Hyponatremia / drug therapy*
  • Infusions, Intravenous
  • Intracranial Aneurysm / complications
  • Male
  • Middle Aged
  • Prospective Studies
  • Randomized Controlled Trials as Topic
  • Retrospective Studies
  • Safety
  • Saline Solution, Hypertonic / administration & dosage
  • Saline Solution, Hypertonic / therapeutic use*
  • Sample Size
  • Sodium / blood
  • Subarachnoid Hemorrhage / complications*
  • Ultrasonography, Doppler, Transcranial
  • Water-Electrolyte Balance / drug effects


  • Acetates
  • Chlorides
  • Saline Solution, Hypertonic
  • Sodium