Albany Medical Center, Albany, NY, 12208, United States.
Cohen Children's Medical Center, New Hyde Park, NY, United States.
Clin Neurol Neurosurg. 2021 Feb;201:106435. doi: 10.1016/j.clineuro.2020.106435. Epub 2020 Dec 15.
3 % hypertonic saline (HS) is a hyperosmolar agent often used to treat elevated intracranial pressure (ICP). However, the resultant hyperchloremia is associated with adverse outcomes in certain patient populations. In this study, HS solution buffered with sodium acetate (HSwSA) is used as an alternative to standard 3 % formulations to reduce overall chloride exposure. Our objectives are to establish whether this alternative agent - with reduced chloride content - is similar to standard 3 % HS in maintaining hyperosmolarity and investigate its effects on hyperchloremia.
A retrospective chart review was conducted from August 1, 2014 to August 1, 2017 on patients receiving hypertonic therapies for ICP management. Patients were categorized into three groups, those that received: (1) 3 % HS for at least 72 h, (2) HSwSA for at least 72 h, or (3) were switched from 3 % HS within 72 h of initiating therapy to HSwSA for at least 72 h.
The average increase in serum osmolality after 72 h of therapy was 21.1 moSm/kg for those only on 3 % HS and 20.3 mOsm/kg for those only on HSwSA. Serum chloride levels after 24 h decreased on average by 2.5 mEq/L after switching from 3% HS to HSwSA and stayed below baseline, whereas matched patients only receiving 3% HS on average had serum chloride levels increase 4.3 mEq/L after 24 h and continued to rise.
Hyperchloremia has been associated with decreased renal perfusion, increasing the risk of acute kidney injury and hyperchloremic metabolic acidosis. Compared to standard 3% HS, our findings suggest an alternative hyperosmolar therapy with less chloride maintains similar hyperosmolarity while reducing overall chloride exposure.
3%高渗盐水（HS）是一种高渗剂，常用于治疗颅内压升高（ICP）。然而，在某些患者人群中，由此产生的高氯血症与不良结局相关。在这项研究中，使用醋酸钠缓冲的 HS 溶液（HSwSA）作为标准 3%制剂的替代物，以减少总体氯暴露。我们的目的是确定这种替代剂-含氯量较低-是否与标准 3%HS 一样，能在维持高渗透压的同时，减少高氯血症的发生。
对 2014 年 8 月 1 日至 2017 年 8 月 1 日期间接受高渗治疗以管理 ICP 的患者进行回顾性图表审查。患者分为三组：（1）至少接受 72 小时 3%HS；（2）至少接受 72 小时 HSwSA；或（3）在开始治疗的 72 小时内从 3%HS 转换为 HSwSA，至少接受 72 小时。
仅接受 3%HS 的患者在治疗 72 小时后血清渗透压平均升高 21.1 mOsm/kg，仅接受 HSwSA 的患者平均升高 20.3 mOsm/kg。从 3%HS 转换为 HSwSA 后，24 小时血清氯水平平均下降 2.5 mEq/L，且低于基线，而匹配的仅接受 3%HS 的患者在 24 小时后平均血清氯水平升高 4.3 mEq/L，且继续升高。
高氯血症与肾灌注减少有关，增加急性肾损伤和高氯性代谢性酸中毒的风险。与标准 3%HS 相比，我们的发现表明，替代高渗疗法的氯含量较低，在维持相似高渗透压的同时，减少总体氯暴露。
