Three-percent saline administration during pediatric critical care transport

Pediatr Emerg Care. 2011 Dec;27(12):1113-7. doi: 10.1097/PEC.0b013e31823aff59.


Objectives: The purpose of this study was to describe the administration of 3% saline (3%S) during pediatric critical care transport.

Methods: A retrospective study was performed on pediatric patients who underwent critical transport to Loma Linda University Children's Hospital from January 1, 2003, to June 30, 2007, and were given 3%S. Patients' demographics, admission diagnosis, route and amount of 3%S administration, serum electrolytes, vital signs, radiographic data, and Glasgow Coma Scale scores were collected and analyzed.

Results: A total of 101 children who received 3%S infusions during pediatric critical care transport were identified. Mean patient age was 5.9 years, and mean patient weight was 27.6 kg. The main indications for infusing 3%S were suspected cerebral edema (41%), intracranial bleed with edema (51%), and symptomatic hyponatremia (6%). The amount of 3%S bolus ranged from 1.2 to 24 mL/kg, with a mean of 5.4 mL/kg. Serum electrolytes before and after 3%S infusion demonstrated significant increases in sodium, chloride, and bicarbonate levels (P < 0.05). A significant reduction was also seen in serum urea nitrogen levels and anion gap. Radiographic imaging performed before 3%S infusion demonstrated findings consistent with concerns of increased intracranial pressure such as intracranial bleed and cerebral edema. The route of initial 3%S infusions was mainly through peripheral intravenous lines (96%). No complications related to the 3%S delivery such as local reactions, renal abnormalities, or central pontine myelinolysis were observed.

Conclusions: It seems 3%S may be administered safely during pediatric critical transport and administration routes can include peripheral lines. With the importance of initiating therapy early to improve patient outcomes, the use of 3%S may benefit transported children with brain injury and suspected intracranial hypertension.

MeSH terms

  • Adolescent
  • Ambulances / statistics & numerical data
  • Brain Edema / drug therapy
  • Brain Edema / etiology
  • Brain Edema / prevention & control
  • Brain Injuries / blood
  • Brain Injuries / complications
  • Brain Injuries / diagnostic imaging
  • Brain Injuries / drug therapy*
  • Brain Injuries / therapy
  • Catheterization, Central Venous
  • Catheterization, Peripheral
  • Child
  • Child, Preschool
  • Critical Care / methods*
  • Dose-Response Relationship, Drug
  • Drug Evaluation
  • Drug Therapy, Combination
  • Female
  • Glasgow Coma Scale
  • Humans
  • Infant
  • Infusions, Intraosseous
  • Intensive Care Units, Pediatric
  • Intracranial Hypertension / drug therapy
  • Intracranial Hypertension / etiology
  • Intracranial Hypertension / prevention & control
  • Male
  • Mannitol / administration & dosage
  • Mannitol / therapeutic use
  • Radiography
  • Respiration, Artificial
  • Retrospective Studies
  • Saline Solution, Hypertonic / administration & dosage
  • Saline Solution, Hypertonic / adverse effects
  • Saline Solution, Hypertonic / therapeutic use*
  • Sodium / blood
  • Transportation of Patients*


  • Saline Solution, Hypertonic
  • Mannitol
  • Sodium