Hypertonic saline in elevated intracranial pressure: past, present, and future

J Intensive Care Med. 2015 Jan;30(1):8-12. doi: 10.1177/0885066613487151. Epub 2013 May 3.


Hypertonic Saline (HS) has been a proven and effective therapy and a safe alternative to mannitol in patients with increase intracranial pressure (ICP). We hereby present a case of 25-year-old women with intracranial bleed secondary to right parietal arteriovenous malformation. Patient underwent surgery for evacuation of hematoma and resection of arteriovenous malformation. Post- operative course was complicated by recurrent episodes of elevated ICP. She received total of 17 doses of 23.4% HS and 30 doses of mannitol with good outcome. Despite reluctance from some clinicians to use HS, hypertonic saline seems to be a safe and effective therapy.

Keywords: cerebral edema; hypertonic saline; intracranial hypertension; intracranial pressure; mannitol; stroke.

Publication types

  • Case Reports
  • Review

MeSH terms

  • Decompressive Craniectomy*
  • Diuretics, Osmotic / administration & dosage*
  • Diuretics, Osmotic / pharmacology
  • Female
  • Humans
  • Intracranial Arteriovenous Malformations / complications*
  • Intracranial Arteriovenous Malformations / diagnosis
  • Intracranial Arteriovenous Malformations / therapy
  • Intracranial Hypertension / diagnosis
  • Intracranial Hypertension / drug therapy
  • Intracranial Hypertension / etiology*
  • Mannitol / administration & dosage*
  • Mannitol / pharmacology
  • Middle Aged
  • Neurophysiological Monitoring
  • Saline Solution, Hypertonic / administration & dosage*
  • Saline Solution, Hypertonic / pharmacology
  • Treatment Outcome


  • Diuretics, Osmotic
  • Saline Solution, Hypertonic
  • Mannitol