(764) Weight-Based Dose Response to 23.4% Sodium Chloride

Introduction: Brain injuries can result in catastrophic complications, including elevated intracranial pressures (ICP). Management of elevated ICPs includes the use of hyperosmolar agents such as hypertonic saline to create an osmotic gradient. Bolus doses of 23.4% sodium chloride are commonly given in 30- or 60-mL volumes. One published study to date examines the effects of a weight-based dosing strategy for 23.4% sodium chloride.

Methods: This was a retrospective, single-center cohort study of patients 18 years or older who were admitted from July 2018 to September 2023 at a major academic center and received at least one dose of 23.4% sodium chloride. High weight-based dosing was defined as ≥ 0.4 mL/kg, and low weight-based dosing was defined as < 0.4 mL/kg. The primary objective was to assess the response in serum sodium levels after dose administration. Secondary endpoints included the response in key physiologic and laboratory parameters.

Results: A total of 234 patients were evaluated, of which 110 were included in the study. No differences were seen in the delta serum sodium levels between groups (4.71 mmol/L vs 3.81 mmol/L, p = 0.12). High dose 23.4% sodium chloride led to a significantly greater reduction in ICP (10.48 mmHg vs 4.96 mmHg, p = 0.047) and a larger increase in serum chloride (6.50 mmol/L vs 4.36 mmol/L, p = 0.01). Low dose 23.4% sodium chloride was associated with a significant decrease in MAP (p = 0.04). There were no significant differences in safety outcomes between groups.

Conclusions: A higher weight-based dosing strategy of 23.4% sodium chloride (> 0.4 mL/kg) did not result in a significant increase in serum sodium levels compared to a lower weight-based dosing strategy ( < 0.4 mL/kg) but did lead to significant ICP reduction.