Administration of hypertonic (3%) sodium chloride acetate in hyponatremic patients with symptomatic vasospasm following subarachnoid hemorrhage

A retrospective study was carried out to evaluatez the effect of hypertonic (3%) saline chloride/acetate on various hemodynamic parameters in mildly h yponatremic patients with symptomatic vasospasm following aneurysmal subara chnoid hemorrhage (SAH). We identified 29 hyponatremic (serum sodium < 135 mEq/L) patients who received hypertonic (3%) sodium chloride/acetate as a c ontinuous infusion. Administration of hypertonic (3%) sodium chloride/aceta te resulted in higher central venous pressures and positive fluid balance, with a concomitant increase in serum sodium and chloride concentrations wit hout metabolic acidosis. There were no changes in mean cerebral blood flow velocities after infusion of hypertonic (3%) sodium chloride/acetate. We fo und no reports of congestive heart failure, pulmonary edema, metabolic acid osis, coagulopathy, intracranial hemorrhages, or central pontine myelinolys is in any of these patients. We conclude that hypertonic (3%) sodium chlori de/acetate can be administered to patients with mild hyponatremia in the se tting of symptomatic vasospasm following SAH without untoward effects. Samp le size and Limitations of a retrospective analysis preclude conclusions ab out safety and efficacy of hypertonic (3%) sodium chloride/ acetate adminis tration in this patient population. However, our results support justificat ion for a prospective, randomized, double-blind trial of hypertonic (3%) so dium chloride/acetate versus normal saline in patients with symptomatic vas ospasm following SAH.