Hypertonic saline for ischemic stroke: a review

  • Rameen Ata Bajwa Medical College, Aga Khan University, Karachi, Pakistan.
  • Angelina Jessani Medical College, Aga Khan University, Karachi, Pakistan.
  • Hanan Farzand Raja Medical College, Aga Khan University, Karachi, Pakistan.
  • Bisma Aziz Dean’s Clinical Research Fellow, Department of Medicine, Aga Khan University, Karachi, Pakistan.
Keywords: Ischemic Stroke, Cerebral Edema, Intracranial Hypertension, Osmotherapy, Hypertonic Saline

Abstract

Background and Objective:

Elevated intracranial pressure (ICP) is a critical complication of ischemic stroke. This review article summarizes existing literature pertaining to the role of hypertonic saline (HTS) in lowering ICP in ischemic stroke patients.

Methods:

Studies were selected using a comprehensive search of several research databases. Studies conducted in adult (aged 18 and older) human patients receiving HTS osmotherapy for elevated ICP were included, encompassing a wide range of neurological conditions and various administration methods, durations, and concentrations of HTS.

Results:

 We found HTS to reduce ICP in ischemic stroke patients, on par effectively, and in some studies, superior to more conventional ICP-lowering methods such as mannitol. Patients with comorbid conditions such as cerebrovascular and renal diseases also tolerated HTS well. The risk of developing hypernatremia was significantly higher in patients receiving HTS osmotherapy. Neurological complications, such as central pontine myelinosis, were not observed in any of the participants; however, no clear benefit regarding the long-term neurologic outcome of these patients has been reported thus far.

Conclusion:

While encouraging, existing literature on the use of HTS as a treatment for elevated ICP still needs to be more conclusive and necessitates further research. Questions regarding duration, optimal concentration of intervention, and method of administration need to be addressed by future randomized controlled trials.

Author Biographies

Angelina Jessani, Medical College, Aga Khan University, Karachi, Pakistan.

Medical College, Aga Khan University

Hanan Farzand Raja, Medical College, Aga Khan University, Karachi, Pakistan.

Medical College, Aga Khan University

Bisma Aziz, Dean’s Clinical Research Fellow, Department of Medicine, Aga Khan University, Karachi, Pakistan.

Dean’s Clinical Research Fellow, Department of Medicine, Aga Khan University

Published
2024-07-28
Section
Review Article