Pulmonary, obstetric and electrolyte infusions
Hypertonic saline 3% drip
HTS
Dosing
| Start | Hyponatremia with severe symptoms: 150 mL over 20 minutes, repeated up to twice until Na rises 5 (Europe 2014; US panel 2013: 100 mL over 10 minutes); slow infusion 0.5–1 mL/kg/h (SALSA). Raised ICP: 250 mL or 2.5–5 mL/kg (ENLS), usually over 10–20 minutes; infusions to a sodium goal per protocol |
|---|---|
| Titrate | By sodium: 20 minutes after each hyponatremia bolus and every 4 hours while 3% runs (Europe 2014); every 4–6 hours on ICP protocols, which often aim for 145–155 |
| Maximum | Chronic hyponatremia: a rise of no more than 8 mEq/L in any 24 hours (guideline limits 10–12). ICP: stop at Na 155–160 or chloride 110–115 (NCS 2020). B. Braun label: 100 mL/h and 400 mL a day, which guideline boluses exceed |
| Common bags | 256.5 mEq in 500 mL (0.513 mEq/mL) |
| Dose units | mL/kg/h, mL/h |
Line and administration
- A large peripheral vein is acceptable for 3% in many protocols, with frequent site checks; 7.5% and stronger go central (ENLS)
- High-alert drug: independent double-check and pump limits; 23.4% is a central-line bolus only, never this channel
Watch for
- Overcorrection: a surge of dilute urine means check Na now; reverse with D5W and desmopressin (electrolytes page)
- Osmotic demyelination days after a fast rise, most likely with Na 105 or less, alcohol use, malnutrition, liver disease or low K
- Hyperchloremic acidosis and pulmonary edema; wean long ICP infusions to avoid rebound edema
Hypertonic saline: full drug monographIndications, mechanism, pharmacokinetics, cautions and every dose the app lists.
In the one-pagers
- Neuro: ICP and StrokeEVD care and osmotic therapy: 3% saline: 2.5–5 mL/kg bolus or infusion: Favored in TBI, ICH; sodium every 4–6 h, keep <160
- Aerosol Drugs and HumidityMucoactive and bland aerosols: Hypertonic saline 7%: CF; non-CF bronchiectasis: Bronchodilator first
- Electrolyte ImbalancesSodium: correct slowly: Severe symptoms (seizures, coma): 3% saline 100–150 mL over 10–20 min, repeated to raise Na about 5 mEq/L.
- Subarachnoid HemorrhageSodium, heart and other complications: Hyponatremia (27–57%): Salt wasting or SIADH; natriuresis, polyuria: Isotonic or 3% saline, fludrocortisone; never fluid-restrict
- Airway Clearance and SuctioningChoosing a technique: Give a bronchodilator or hypertonic saline before the session, and inhaled antibiotics after it.
- DKA and HHSComplications and nursing monitoring: Cerebral edema: rare in adults (<0.1%), about 30% fatal; more common in children. Report new headache or vomiting after treatment starts, falling LOC, slowing heart rate or incontinence at once. Mannitol or hypertonic saline treats it.
Practice Neuro: ICP and Stroke questions free101 exam-style questions with rationales on the topic where hypertonic saline 3% comes up most. No account or download needed.
Other pulmonary, obstetric and electrolyte infusions
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For education and exam preparation only. Follow your institution’s protocols. Study aid: check every dose against the order, the bag label, your pump library and your institution's protocol.