COLLEGE OF PHARMACY Safety and Efficacy of Hypertonic Saline Via Peripheral Venous Catheter and Intraosseous Administration: What is the Evidence? A Literature Review Emily Farina, Adrianna Goodin, Marissa Mauro Advisor: Amber E. King, PharmD, BCPS, FNAP
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C O L L E G E O F P H A R M A C Y
Safety and Efficacy of Hypertonic Saline Via Peripheral Venous Catheter and Intraosseous Administration: What is the Evidence? A Literature Review
• Standard of care: central venous catheters• 3 trials consisting of 26-105 patients• No comparison group• Outcomes• Increased serum sodium levels and net urine output for HF patients• TBIs: 47% patients GCS returned to normal, decrease in
intracranial pressure within one and 4 hr of both single and cluster hypertonic bolus administration
Peripheral Hypertonic Administration Efficacy
• Population:10,20
• Geriatric patients with hyponatremic encephalopathy• Adults with hyponatremia (serum Na <120mEq/L)
• 2 trials consisting of 25-64 patients• 500 mL of 3% HTS• 3% HTS + 1-4 mcg desmopressin
• No comparison group• Outcomes:• CNS symptoms resolved in 97% of encephalopathy cases• Mean increase in sodium levels after 4 & 24 hr was 2.6 & 5.8 mEq/L,
respectively
Intraosseous Administration of Hypertonic Saline Efficacy• Population:7,15
• Critically ill adults with an acute neurologic event that required hyperosmolar therapy
• Adults with clinical and imaging signs of intracranial hypertension
• 2 trials consisting of 5-76 patients• 3% HTS IO infusion at 25-100 mL/hr for 24 hr• 23.4% HTS IO infusion for 3-5 min + 30 mL bolus dose
• IO more rapid route of administration• Serum sodium levels had risen appropriately
• 23.4% HTS associated with smaller increase in mean sodium level
Conclusion
• Based on available literature, there are minimal complications associated with HTS via peripheral and central lines, however the quality of the data is low
• Efficacy data is limited for HTS administration via peripheral, central, and intraosseous administration
• Future RCTs still need to be performed to better assess safety and efficacy outcomes of all routes
• Consider peripheral administration for patients with similar characteristics to those in the studies
Special thanks to Fred Rincon, MD, MSc, MB.Ethics, FACP, FCCP, FCCM
Questions?
References
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