Hypertonic saline

3%, 10% and 23.4%, 100ml vials (IV)

Executive Summary

(December 4, 2023)

Hypertonic saline solutions (HTS) are electrolyte concentrates of NaCl (over 0.9%) and  considered to be high alert medications (4) that are cautiously used to treat symptomatic hyponatremia (13) and acute intracranial hypertension (IH) secondary to multiple causes, but mainly to traumatic brain injury (3, 5, 10, 11). 

Adult dose for acute intracranial hypertension caused by TBI

NaCl 3%, 2 ml/kg IV in 15 minutes bolus

Adult dose (acute intracranial hypertension - 3%, 10%, 23.4%)

Adult dose for acute intracranial hypertension caused by TBI



Adult dose (symptomatic severe hyponatremia)

Adult dose for symptomatic severe hyponatremia (12, 13)

“Symptomatic” means presenting seizures or coma, having reasonably ruled out other causes. 

“Severe” hyponatremia: Na <125mEq/L.

If no aggressive management is preferred, correction velocity should be established according to sodium concentration, age, weight, gender, and the specific chosen solution. Recommended calculator: 

Advantages of HTS over mannitol

Warnings on Hyponatremia Correction

Osmotic Demyelination Syndrome (ODS)


Other significant adverse effects: hypernatremia, hyperchloremia. hyperchloremic metabolic acidosis. (9).


Minor adverse effects: infusion site reactions (9).


Acute Intracranial Hypertension

Han C, Yang F, Guo S, Zhang J. Hypertonic Saline Compared to Mannitol for the Management of Elevated Intracranial Pressure in Traumatic Brain Injury: A Meta-Analysis. Front Surg. 2022;8:765784. Published 2022 Jan 7. doi:10.3389/fsurg.2021.765784
Pubmed Removed due to retraction of the article.

Symptomatic Hyponatremia

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