Brief Article
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World J Crit Care Med. May 4, 2014; 3(2): 61-67
Published online May 4, 2014. doi: 10.5492/wjccm.v3.i2.61
Variable change in renal function by hypertonic saline
Jesse J Corry, Panayiotis Varelas, Tamer Abdelhak, Stacey Morris, Marlisa Hawley, Allison Hawkins, Michelle Jankowski
Jesse J Corry, Panayiotis Varelas, Tamer Abdelhak, Stacey Morris, Marlisa Hawley, Allison Hawkins, Department of Neurology, Henry Ford Hospital, Marshfield, WI 54449, United States
Jesse J Corry, Panayiotis Varelas, Tamer Abdelhak, Department of Neurosurgery, Henry Ford Hospital, Marshfield, WI 54449, United States
Michelle Jankowski, Department of Biostatistics, Henry Ford Hospital, Marshfield, WI 54449, United States
Author contributions: Corry JJ contributed to study concept and design, data review, statistical analysis and review, manuscript authorship; Varelas P and Abdelhak T participated in data review, manuscript authorship and editing; Morris S, Hawley M and Hawkins A contributed to data collection, manuscript editing; Jankowski M contributed to statistical analysis, manuscript methods authorship and editing; all authors approved final revision.
Correspondence to: Jesse J Corry, MD, Department of Neurology, Henry Ford Hospital, Marshfield, 000 N. Oak Avenue, 4F3, Marshfield, WI 54449, United States. corry.jesse@marshfieldclinic.org
Telephone: +1-715-079562 Fax: +1-715-3875727
Received: September 16, 2013
Revised: December 9, 2013
Accepted: January 13, 2014
Published online: May 4, 2014
Processing time: 246 Days and 14 Hours
Abstract

AIM: To investigate the effects of hypertonic saline in the neurocritical care population.

METHODS: We retrospectively reviewed our hospital’s use of hypertonic saline (HS) since March of 2005, and prospectively since October 2010. Comparisons were made between admission diagnoses, creatinine change (Cr), and HS formulation (3% NaCl, 3% NaCl/sodium acetate mix, and 23.4% NaCl) to patients receiving normal saline or lactated ringers. The patients (n = 1329) of the retrospective portion were identified. The data presented represents the first 230 patients with data.

RESULTS: Significant differences in Acute Physiology and Chronic Health Evaluation II scores and Glasgow Coma Scale scores occurred between different saline formulations. No significant correlation of Cl- or Na+ with Cr, nor with saline types, occurred. When dichotomized by diagnosis, significant correlations appear. Traumatic brain injury (TBI) patients demonstrated moderate correlation between Na+ and Cr of 0.45. Stroke patients demonstrated weak correlations between Na+ and Cr, and Cl- and Cr (0.19 for both). Patients receiving HS and not diagnosed with intracerebral hemorrhage, stroke, subarachnoid hemorrhage, or TBI demonstrated a weak but significant correlation between Cl- and Cr at 0.29.

CONCLUSION: Cr directly correlates with Na+ or Cl- in stroke, Na+ in TBI, and Cl- in other populations. Prospective comparison of HS and renal function is needed.

Keywords: Hypertonic saline solution, Sodium chloride, Acute kidney injury, Cerebral edema, Critical care

Core tip: This work adds to the literature that changes in Na+ and Cl- in the neurocritical care population correlate to adverse changes in renal function. It is critical for the neurointensivist to remain cognizant of this when choosing whether or not to use hypertonic saline, and what to monitor when doing so. Unlike previous work, this data suggests some diseases may have more or less a change in renal function from Na+ or Cl-. This argues for further study of how the formulations of these fluids may change outcome in the neurocritically ill.