Section 13 · Monograph
Hypertonic saline
Reviewed Nov 2026FDA label
3% / 23.4% NaClOsmotic agent
- Forms
- IV: 3% bags | 23.4% vials
- Dose
- 3%: 150-250mL bolus (or 2-5mL/kg) | 23.4%: 30mL via central line over 10-20 min; target Na 145-155
- MOA
- ↑Serum Na+/osmolality, ↓brain edema and ICP
Indications
- Reduction of elevated intracranial pressure and cerebral edema (off-label, standard of care)FDA-labeled
- Acute severe symptomatic hyponatremiaFDA-labeled
Mechanism of Action
- Raises serum sodium and osmolality, drawing water out of brain parenchyma and reducing ICP and edema
Full Dosing
Adult / usual
- 3%: 150-250mL bolus (or 2-5mL/kg) over 10-30 minutes
- 23.4%: 30mL via central line over 10-20 minutes
- ICP management goal: serum sodium about 145-155mEq/L
- Chronic hyponatremia: limit sodium rise to no more than 8-10mEq/L in 24 hours
Contraindications
- Hypernatremia
- Avoid overly rapid correction of chronic hyponatremia (osmotic demyelination risk)
- 23.4% must not be given peripherally or undiluted without central access
Drug Interactions
- Combination with mannitol or loop diuretics increases risk of volume depletion and electrolyte shifts
Adverse Effects
- Hypernatremia
- Osmotic demyelination with overly rapid sodium rise
- Phlebitis (peripheral 3%); tissue necrosis if 23.4% extravasates
- Volume overload and pulmonary edema
- Hyperchloremic acidosis
- Rebound ICP elevation
Monitoring Parameters
- Serum sodium every 4-6 hours during therapy
- Osmolality, chloride, volume status
- Central venous access for 23.4%
Pregnancy & Lactation
- Use only when clearly needed; limited data