Intravenous hypertonic saline use in the pediatric emergency department

Area of Science:

• Pediatric Emergency Medicine
• Critical Care Pharmacology
• Neurology

Background:

• Intravenous hypertonic saline (IHS) is a critical medication for managing various pediatric emergencies.
• Understanding its current utilization patterns, optimal dosing, and administration methods in pediatric emergency departments (EDs) is essential for clinical practice.
• Previous literature has not fully detailed the specific applications and delivery of IHS in high-volume pediatric ED settings.

Purpose of the Study:

• To characterize the utilization, dosing strategies, and administration practices of intravenous hypertonic saline (IHS) within a pediatric emergency department.
• To identify the primary clinical indications for IHS administration in pediatric patients.
• To evaluate the safety and feasibility of IHS administration in this setting.

Main Methods:

• Retrospective chart review of patients aged 0 to 18 years who received IHS.
• Data collection included patient demographics, clinical indications, IHS dosage, administration time, and route of administration.
• Analysis focused on identifying trends in IHS use over a 4-year period in a pediatric ED with over 50,000 annual visits.

Main Results:

• Over 4 years, 56 pediatric patients received IHS for conditions including traumatic brain injury (34%), diabetic ketoacidosis (32%), and hyponatremia (10.7%).
• The median IHS dose was 4.1 mL/kg, with 87% administered via peripheral IV catheters, often rapidly (26.8% within 10 minutes).
• No adverse effects associated with IHS administration were documented during the study period.

Conclusions:

• Intravenous hypertonic saline use is growing in pediatric emergency departments.
• The common dosing range is 3 to 5 mL/kg, and rapid infusion via peripheral IV is feasible and safe.
• IHS can be effectively administered without the need for central venous access in emergent pediatric care settings.