Hypertonic saline and mannitol are commonly used for management of acute intracranial hypertension and cerebral herniation.
The choice of medication is often limited by venous access.
23.4% NaCl has been shown to decrease intracranial pressure in patients refractory to mannitol.
It requires administration through a central line to avoid sclerosis of the peripheral veins and tissue necrosis with extravasation.
Intraosseous (IO) access provides a more rapid route for 23.4% NaCl administration.
No complications were observed relating to IO insertion site.
Transient hypotension occurred in more patients who received 23.4% NaCl via IO vs. central line.
Bottom Line: Use of IO allows more rapid administration of 23.4% NaCl with no immediate serious complications.
References
Wang J, Fang Y, Ramesh S, et al. Intraosseous administration of 23.4% NaCl for treatment of intracranial hypertension. Neurocrit Care. 2019;30(2):364-371.
