Objectives: The objective of this study was to describe the use, dosing, and administration of intravenous hypertonic saline (IHS) use in a pediatric emergency department.
Methods: This was a retrospective chart review of patients 0 to 18 years receiving IHS as part of their management in a pediatric ED with an annual volume of more than 50,000 visits.
Results: Over 4 years, 56 patients received IHS as part of their management in the emergency department. Clinical scenarios for IHS administration included traumatic brain injury with concern for increased intracranial pressure in 19 patients (34%), diabetic ketoacidosis with altered mental status in 18 (32%), hyponatremia without seizure activity in 6 (10.7%), hyponatremic seizure in 3 (5.4%), and altered mental status secondary to a nontraumatic, non-diabetic ketoacidosis cause in 10 (17.9%). The median age of the patients was 11.3 years (interquartile range, 6-13.9 years) receiving a median dose of 4.1 mL/kg (interquartile range, 3.08-5 mL/kg) of IHS. The median time for administration of the IHS was 17 minutes, with 87% of doses given via peripheral intravenous catheters. Approximately one fourth (26.8%) of patients received their dose in 10 minutes or less, with 7.2% of patients receiving a bolus of IHS in 3 minutes or less. We found no evidence of adverse effects.
Conclusions: Intravenous hypertonic saline use is increasing within the pediatric emergency department. Within this institution, it is most frequently used at a dosing range of 3 to 5 mL/kg and does not require central venous access for rapid infusion.