Saturday, April 10, 2010

Saline bullets (and hypertonic saline) for increased intracranial pressure.

Saline bullets are not FDA approved but rather a novel effective way to lower increased intracranial pressure acutely.  The idea was proposed by Geoffrey Ling MD at a lecture based on his experience in the military.  The advantage is that hypertonic saline, in this case a saline bullet, does not promote diuresis just creates a gradient that treats increased ICP.  Per Dr. Ling, a saline bullet of 23 % NaCL, 30 cc, decreases ICP by 50 % and sustains the decrease for about eight hours.  It needs to be given through a central line.  The 23 percent saline infusion is available in every pharmacy as a basis for TPN and needs to be cannibalized from that cart since not likely to be available from pharmacy for stated purpose of controlling ICP.  Once the goal is achieved Ling uses a 3 percent saline infusion at 75 cc per hour, of half NaCl and half Naacetate

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