hypertonic saline solution


Summary: Hypertonic sodium chloride solution. A solution having an osmotic pressure greater than that of physiologic salt solution (0.9 g NaCl in 100 ml purified water).

Top Publications

  1. da Silva J, de Lima F, Valenca M, de Azevedo Filho H. Hypertonic saline more efficacious than mannitol in lethal intracranial hypertension model. Neurol Res. 2010;32:139-43 pubmed publisher
    ..Although mannitol is the mainstay of hyperosmolar therapy, hypertonic saline (HS) is emerging as an effective alternative to traditional osmotic agents...
  2. Bulger E, Jurkovich G, Nathens A, Copass M, Hanson S, Cooper C, et al. Hypertonic resuscitation of hypovolemic shock after blunt trauma: a randomized controlled trial. Arch Surg. 2008;143:139-48; discussion 149 pubmed publisher
    ..Massive transfusion may be a better predictor of ARDS than prehospital hypotension. The use of HSD may offer maximum benefit in patients at highest risk of ARDS. ..
  3. Bing M, Zheng lu H, Hui C, Xian D, Jian H. Variations of p38 MAPK and sICAM-1 with therapeutic effect of different resuscitation fluids on severe traumatic patients. Chin J Traumatol. 2007;10:263-8 pubmed
    ..During severe trauma, the levels of sICAM-1 and p38 MAPK, as well as the incidence and mortality of MODS are lower when HS and ALB are used than single lactated LR solution is used. ..
  4. Elliott M, Jallo J, Barbe M, Tuma R. Hypertonic saline attenuates tissue loss and astrocyte hypertrophy in a model of traumatic brain injury. Brain Res. 2009;1305:183-91 pubmed publisher
    ..Delayed treatment of hypertonic saline resulted in the greatest reduction in tissue loss compared to all other treatments indicating that there is a therapeutic window for hypertonic saline use after traumatic brain injury. ..
  5. Strandvik G. Hypertonic saline in critical care: a review of the literature and guidelines for use in hypotensive states and raised intracranial pressure. Anaesthesia. 2009;64:990-1003 pubmed publisher
    ..There is no survival or outcome benefit with the use of hypertonic saline solutions for raised intracranial pressure. Recommendations for clinical use and future directions of clinical research are presented. ..
  6. Koch A, Kaske M. Clinical efficacy of intravenous hypertonic saline solution or hypertonic bicarbonate solution in the treatment of inappetent calves with neonatal diarrhea. J Vet Intern Med. 2008;22:202-11 pubmed publisher
    The clinical efficacy of IV administered hypertonic saline solution and hypertonic bicarbonate solution (HBS) in the treatment of inappetent diarrheic calves has not been compared yet...
  7. Huang G, Shih C, Wu C, Hu M, Tsai C, Liaw W, et al. Hypertonic saline, mannitol and hydroxyethyl starch preconditioning of platelets obtained from septic patients attenuates CD40 ligand expression in vitro. J Trauma. 2010;68:331-6 pubmed publisher
    ..These resuscitation fluids may have an anti-inflammatory action when administered to septic patients. ..
  8. Kvalheim V, Farstad M, Haugen O, Brekke H, Mongstad A, Nygreen E, et al. A hyperosmolar-colloidal additive to the CPB-priming solution reduces fluid load and fluid extravasation during tepid CPB. Perfusion. 2008;23:57-63 pubmed
    ..5) and 112 (1.6) mmol/l in Group H. To conclude: addition of 7.2% hypertonic saline and 6% poly (O-2-hydroxyethyl) starch solution to crystalloid CPB prime reduces fluid needs and FER during tepid CPB. ..
  9. Boomer L, Jones W, Davis B, Williams S, Barber A. Optimal fluid resuscitation: timing and composition of intravenous fluids. Surg Infect (Larchmt). 2009;10:379-87 pubmed publisher
    ..Interleukin-10 was elevated significantly in non-resuscitated rats. Cellular destruction and a pro-inflammatory response follow hemorrhagic shock. Early resuscitation with isotonic crystalloid fluids decreases these responses. ..

More Information


  1. Hirsh M, Hashiguchi N, Junger W. Hypertonic saline increases gammadeltaT cell-mediated killing of activated neutrophils. Crit Care Med. 2008;36:3220-5 pubmed publisher
    ..Hypertonic saline resuscitation may therefore protect host tissues by enhancing neutrophil clearance from the lungs. ..
  2. Fernandes T, Pontieri V, Moretti A, Teixeira D, Abatepaulo F, Soriano F, et al. Hypertonic saline solution increases the expression of heat shock protein 70 and improves lung inflammation early after reperfusion in a rodent model of controlled hemorrhage. Shock. 2007;27:172-8 pubmed
    b>Hypertonic saline solution (HS solution, NaCl 7.5%) has shown to restore hemodynamic parameters in hemorrhagic shock and to decrease the inflammation triggered by ischemia-reperfusion injury (I-R)...
  3. Kvalheim V, Farstad M, Steien E, Mongstad A, Borge B, Kvitting P, et al. Infusion of hypertonic saline/starch during cardiopulmonary bypass reduces fluid overload and may impact cardiac function. Acta Anaesthesiol Scand. 2010;54:485-93 pubmed publisher
    ..An intraoperative infusion of HSH during cardiac surgery contributes to reduced fluid loading and an improvement in the post-operative cardiac performance. No adverse effects of the HSH infusion were observed. ..
  4. Summy Long J, Hu S. Peripheral osmotic stimulation inhibits the brain's innate immune response to microdialysis of acidic perfusion fluid adjacent to supraoptic nucleus. Am J Physiol Regul Integr Comp Physiol. 2009;297:R1532-45 pubmed publisher
    ..Acidosis-induced cellular injury from microdialysis activated the brain's innate immune response by a mechanism inhibited by peripheral osmotic stimulation. ..
  5. Carlsten C, Aitken M, Hallstrand T. Safety of sputum induction with hypertonic saline solution in exercise-induced bronchoconstriction. Chest. 2007;131:1339-44 pubmed
    ..We conclude that SI can be performed safely following exercise challenge in asthmatics with EIB, and that the severity of EIB prior to SI is not a major determinant of bronchoconstriction during SI. ..
  6. Oddo M, Levine J, Frangos S, Carrera E, Maloney Wilensky E, Pascual J, et al. Effect of mannitol and hypertonic saline on cerebral oxygenation in patients with severe traumatic brain injury and refractory intracranial hypertension. J Neurol Neurosurg Psychiatry. 2009;80:916-20 pubmed publisher
    ..5% hypertonic saline administered as second tier therapy is associated with a significant increase in brain oxygenation, and improved cerebral and systemic haemodynamics. ..
  7. Sell S, Avila M, Yu G, Vergara L, Prough D, Grady J, et al. Hypertonic resuscitation improves neuronal and behavioral outcomes after traumatic brain injury plus hemorrhage. Anesthesiology. 2008;108:873-81 pubmed publisher
    ..This study supports the therapeutic benefits of hypertonic resuscitation after TBI plus hemorrhagic hypotension. ..
  8. Carpenter J, WEINSTEIN S, Myseros J, Vezina G, Bell M. Inadvertent hyponatremia leading to acute cerebral edema and early evidence of herniation. Neurocrit Care. 2007;6:195-9 pubmed
  9. Baker A, Rhind S, Morrison L, Black S, Crnko N, Shek P, et al. Resuscitation with hypertonic saline-dextran reduces serum biomarker levels and correlates with outcome in severe traumatic brain injury patients. J Neurotrauma. 2009;26:1227-40 pubmed publisher
    ..Pre-hospital resuscitation with HSD is associated with a reduction in serum S100B, NSE, and MBP concentrations, which are correlated with better outcome after severe TBI. ..
  10. Morrison L, Rizoli S, Schwartz B, Rhind S, Simitciu M, Perreira T, et al. The Toronto prehospital hypertonic resuscitation-head injury and multi organ dysfunction trial (TOPHR HIT)--methods and data collection tools. Trials. 2009;10:105 pubmed publisher
    ..In addition all the data collection tools had to be derived de novo as none existed in the literature. NCT00878631. ..
  11. Vincenzi R, Cepeda L, Pirani W, Sannomyia P, Rocha e Silva M, Cruz R. Small volume resuscitation with 3% hypertonic saline solution decrease inflammatory response and attenuates end organ damage after controlled hemorrhagic shock. Am J Surg. 2009;198:407-14 pubmed publisher
    Recently, studies have been conducted examining the efficacy of 3% hypertonic saline solution (HS) for the treatment of traumatic brain injury; however, few studies have analyzed the effects of 3% hemorrhagic shock during hemorrhagic ..
  12. Farstad M, Haugen O, Kvalheim V, Hammersborg S, Rynning S, Mongstad A, et al. Reduced fluid gain during cardiopulmonary bypass in piglets using a continuous infusion of a hyperosmolar/hyperoncotic solution. Acta Anaesthesiol Scand. 2006;50:855-62 pubmed
    ..No electrolyte or acid-base disturbances were present. The intracranial pressure remained stable in the HSH group. ..
  13. Verheij J, van Lingen A, Beishuizen A, Christiaans H, de Jong J, Girbes A, et al. Cardiac response is greater for colloid than saline fluid loading after cardiac or vascular surgery. Intensive Care Med. 2006;32:1030-8 pubmed
    ..To study the effects on volume expansion and myocardial function of colloids or crystalloids in the treatment of hypovolaemic hypotension after cardiac and major vascular surgery...
  14. Harutjunyan L, Holz C, Rieger A, Menzel M, Grond S, Soukup J. Efficiency of 7.2% hypertonic saline hydroxyethyl starch 200/0.5 versus mannitol 15% in the treatment of increased intracranial pressure in neurosurgical patients - a randomized clinical trial [ISRCTN62699180]. Crit Care. 2005;9:R530-40 pubmed
    ..5 can be recommended as effective and safe. The advantage of 7.2% NaCl/HES 200/0.5 might be explained by local osmotic effects, because there were no clinically relevant differences in hemodynamic clinical chemistry parameters. ..
  15. Powers K, Zurawska J, Szaszi K, Khadaroo R, Kapus A, Rotstein O. Hypertonic resuscitation of hemorrhagic shock prevents alveolar macrophage activation by preventing systemic oxidative stress due to gut ischemia/reperfusion. Surgery. 2005;137:66-74 pubmed
    ..This represents a novel mechanism whereby HTS exerts its immunomodulatory effects. ..
  16. Poli de Figueiredo L, Cruz R, Silva E, Yada Langui M, Rocha e Silva M. Sustained gastric mucosal acidosis after hemorrhage in spite of rapid hemodynamic restoration with blood or hypertonic/hyperoncotic solution. J Invest Surg. 2005;18:257-64 pubmed
  17. Paksoy Y, Odev K, Sahin M, Arslan A, Koc O. Percutaneous treatment of liver hydatid cysts: comparison of direct injection of albendazole and hypertonic saline solution. AJR Am J Roentgenol. 2005;185:727-34 pubmed
    ..b>Hypertonic saline solution inactivated the scolices from the beginning of the treatment...
  18. de Meer G, Marks G, de Jongste J, Brunekreef B. Airway responsiveness to hypertonic saline: dose-response slope or PD15?. Eur Respir J. 2005;25:153-8 pubmed
    ..In conclusion, the continuous relationship between airway responsiveness and asthma symptoms is in favour of a noncensored measure of airway responsiveness, such as the dose-response slope. ..
  19. Filho J, Machado M, Nani R, Rocha J, Figueira E, Bacchella T, et al. Hypertonic saline solution increases cerebral perfusion pressure during clinical orthotopic liver transplantation for fulminant hepatic failure: preliminary results. Clinics (Sao Paulo). 2006;61:231-8 pubmed
    ..In the present study, we hypothesized that the favorable effects of hypertonic saline solution (NaCl 7...
  20. Ke Q, Zheng S, Liang T, Xie H, Xia W. Pretreatment of hypertonic saline can increase endogenous interleukin 10 release to attenuate hepatic ischemia reperfusion injury. Dig Dis Sci. 2006;51:2257-63 pubmed
    ..So we concluded that HTS pretreatment attenuates hepatic I/R injury by increasing the release of endogenous IL-10. ..
  21. Adamides A, Winter C, Lewis P, Cooper D, Kossmann T, Rosenfeld J. Current controversies in the management of patients with severe traumatic brain injury. ANZ J Surg. 2006;76:163-74 pubmed
    ..Well-designed, large, randomized controlled trials are needed to determine therapies that are safe and effective from those that are ineffective or harmful. ..
  22. Machado M, Coelho A, Pontieri V, Sampietre S, Molan N, Soriano F, et al. Local and systemic effects of hypertonic solution (NaCl 7.5%) in experimental acute pancreatitis. Pancreas. 2006;32:80-6 pubmed
    ..9%) 1 hour after AP; group HTS, treatment with hypertonic saline solution (NaCl 7.5%) 1 hour after AP. AP was induced by injection of 2...
  23. Rocha e Silva M, Poli de Figueiredo L. Small volume hypertonic resuscitation of circulatory shock. Clinics (Sao Paulo). 2005;60:159-72 pubmed
    ..These objections stem mainly from experimental studies, but there are few signs that they may be of real clinical significance. This review attempts to cover the earlier and the more recent developments in this field. ..
  24. Yildizdas D, Altunbasak S, Celik U, Herguner O. Hypertonic saline treatment in children with cerebral edema. Indian Pediatr. 2006;43:771-9 pubmed
    ..Hypertonic saline seems to be more effective than mannitol in the cerebral edema. ..
  25. Dubick M, Bruttig S, Wade C. Issues of concern regarding the use of hypertonic/hyperoncotic fluid resuscitation of hemorrhagic hypotension. Shock. 2006;25:321-8 pubmed
  26. Cruz R, Yada Langui M, Garrido A, Figueiredo L, Rocha e Silva M. [Early effects of 7.5% hypertonic saline solution on splanchnic perfusion after hemorrhagic shock]. Acta Cir Bras. 2006;21:106-12 pubmed
    ..Gastrointestinal tonometry clearly represents a useful tool for monitoring splanchnic perfusion in patients in hemodynamic shock. ..
  27. Bender R, Breil M, Heister U, Dahmen A, Hoeft A, Krep H, et al. Hypertonic saline during CPR: Feasibility and safety of a new protocol of fluid management during resuscitation. Resuscitation. 2007;72:74-81 pubmed
    ..HHS after CA is feasible and safe and might improve short term survival after CPR. However, whether giving HHS could be a useful measure to increase resuscitation success after out-of-hospital CA requires a larger preclinical trial. ..
  28. Rizoli S, Rhind S, Shek P, Inaba K, Filips D, Tien H, et al. The immunomodulatory effects of hypertonic saline resuscitation in patients sustaining traumatic hemorrhagic shock: a randomized, controlled, double-blinded trial. Ann Surg. 2006;243:47-57 pubmed
  29. Homma H, Deitch E, Feketeova E, Lu Q, Berezina T, Zaets S, et al. Small volume resuscitation with hypertonic saline is more effective in ameliorating trauma-hemorrhagic shock-induced lung injury, neutrophil activation and red blood cell dysfunction than pancreatitic protease inhibition. J Trauma. 2005;59:266-72 pubmed
    ..Small volume resuscitation with HTS is more effective than RL and nafamostat in limiting T/HS-induced acute lung injury, neutrophil activation and red blood cell injury. ..
  30. Ranawaka R, Weerakoon H. Randomized, double-blind, comparative clinical trial on the efficacy and safety of intralesional sodium stibogluconate and intralesional 7% hypertonic sodium chloride against cutaneous leishmaniasis caused by L. donovani. J Dermatolog Treat. 2010;21:286-93 pubmed publisher
    ..24 injections). HS was effective, but needed an average of 5.27 injections in total per lesion. HS was cheap, with no risk of systemic side effects and was easily available at all centers. ..
  31. Karakitsos D, Karabinis A. Hypothermia therapy after traumatic brain injury in children. N Engl J Med. 2008;359:1179-80 pubmed
  32. Okuyucu S, Akoglu E, Babayigit C, Akoglu S, Dagli S. Ex vivo tracheal mucociliary clearance in rats: comparisons of nebulization versus irrigation with lactated Ringer and saline solutions. J Otolaryngol Head Neck Surg. 2009;38:422-6 pubmed
    ..Lactated Ringer solution is better than saline solution at enhancing mucociliary clearance, but nebulized distilled water is superior to the tested irrigation solutions in rat tracheal epithelium. ..
  33. Calikoglu C, Akgül M, Akgül O, Karatas A. Effects of decompressive craniectomy, hypertonic saline solution and mannitol on an experimental model of cerebral ischemia. Ulus Travma Acil Cerrahi Derg. 2015;21:425-31 pubmed publisher
    ..Combined treatment approaches performed to decrease infarction volume also resulted in favorable outcomes. ..
  34. Valderramas S, Atallah A. Effectiveness and safety of hypertonic saline inhalation combined with exercise training in patients with chronic obstructive pulmonary disease: a randomized trial. Respir Care. 2009;54:327-33 pubmed
    ..Hypertonic saline was associated with adverse effects. It is unclear whether the only predictor of improved functional exercise capacity was exercise training. (ClinicalTrials.gov number, NCT00639236.). ..
  35. Zehnder L, Schulzki T, Goede J, Hayes J, Reinhart W. Erythrocyte storage in hypertonic (SAGM) or isotonic (PAGGSM) conservation medium: influence on cell properties. Vox Sang. 2008;95:280-7 pubmed publisher
    ..All other parameters, such as echinocytosis, decreased RBC deformability and aggregability, and increased blood viscosity was similar for both additive solutions and remained a major problem of blood banking. ..
  36. Loram L, Horwitz E, Bentley A. Gender and site of injection do not influence intensity of hypertonic saline-induced muscle pain in healthy volunteers. Man Ther. 2009;14:526-30 pubmed publisher
    ..Experimentally induced muscle pain is equivalent in intensity and quality in the leg and back muscle. Gender does not influence muscle pain intensity but does influence sensitivity to pressure and the description of pain. ..
  37. Targosz Korecka M, Sułowicz W, Czuba P, Szymonski M, Miklaszewska M, Pietrzyk J, et al. [Erytrocyte membrane change due to the chemical treatment studied with atomic force microscopy]. Przegl Lek. 2009;66:1031-5 pubmed
    ..Based on the contact and non-contact AFMs study the consecutive stages of RBCs surface modification were observed. Scanning electron microscopy pictures of erythrocytes were presented for comparison. ..
  38. Werner H, Slezak A. [Asymmetry of voltage concentration boundary layers effect in double-membrane diffusive cell]. Polim Med. 2008;38:3-10 pubmed
    ..The measure of these properties is an adequate asymmetry coefficient. The value of this effect depends on the concentration of the solutions and the configuration of double-membrane diffusive cell. ..
  39. Wang W, Hu S, Wu H, Shan H, Liu Y. [The effect of NaCl solution with different concentration on the resuscitation of hemorrhagic shock]. Zhonghua Yi Xue Za Zhi. 2010;90:201-4 pubmed
    ..05), the group of 4.5% maintain the best lever. The mean BP of patients rise quickly and continue for a long time, in the group of 4.5%. Meanwhile the internal environment of the body maintain relatively stable in the group of 4.5%. ..
  40. Scaife E, Statler K. Traumatic brain injury: preferred methods and targets for resuscitation. Curr Opin Pediatr. 2010;22:339-45 pubmed publisher
    ..In addition, vogue methods such as hypothermia, hypertonic saline, and aggressive surgical decompression may prove to impact brain swelling and outcomes. ..
  41. Cao R, Jiang S, Duan L, Xiong Y, Gao B, Rao Z. Hypertonic stimulation induces synthesis and release of glutamate in cultured rat hypothalamic astrocytes and C6 cells. Neurosci Bull. 2008;24:359-66 pubmed publisher
    ..HS induced cultured rat hypothalamic astrocytes or C6 cells to synthesize and release glutamate; CBX could block glutamate release, but could not disrupt glutamate synthesis. ..
  42. Fooanant S, Chaiyasate S, Roongrotwattanasiri K. Comparison on the efficacy of dexpanthenol in sea water and saline in postoperative endoscopic sinus surgery. J Med Assoc Thai. 2008;91:1558-63 pubmed
    ..Dexpanthenol is an alternative treatment, which may be useful in young children and complicated cases. ..
  43. Huang G, Hu M, Lee C, Tsai C, Lin T, Li C. Can hypertonic saline influence platelet P selectin expression and platelet-leukocyte aggregation?. Am J Emerg Med. 2010;28:37-43 pubmed publisher
    ..Dilutions of other solutions caused the least disturbance of platelet activation. ..
  44. Fernandes C, Llimona F, Godoy L, Negri E, Pontieri V, Moretti A, et al. Treatment of hemorrhagic shock with hypertonic saline solution modulates the inflammatory response to live bacteria in lungs. Braz J Med Biol Res. 2009;42:892-901 pubmed
    ..We conclude that HS is effective in reducing the early inflammatory response to infection after I-R, and that this phenomenon is achieved by modulation of factors other than expression of innate immunity components. ..
  45. Licata G, Tuttolomondo A, Licata A, Parrinello G, Di Raimondo D, Di Sciacca R, et al. Clinical Trial: High-dose furosemide plus small-volume hypertonic saline solutions vs. repeated paracentesis as treatment of refractory ascites. Aliment Pharmacol Ther. 2009;30:227-35 pubmed publisher
    ..Larger studies will be needed to evaluate long-term outcomes such as readmission and mortality. ..
  46. Flume P, Mogayzel P, Robinson K, Rosenblatt R, Quittell L, Marshall B. Cystic fibrosis pulmonary guidelines: pulmonary complications: hemoptysis and pneumothorax. Am J Respir Crit Care Med. 2010;182:298-306 pubmed publisher
    ..There may be intermittent pulmonary exacerbations or acute worsening of infection and obstruction, which require more intensive therapies. Hemoptysis and pneumothorax are complications commonly reported in patients with cystic fibrosis...
  47. Chen M, Hu D, Pan Z, Lu C, Xue C, Aass I. Curcumin protects against hyperosmoticity-induced IL-1beta elevation in human corneal epithelial cell via MAPK pathways. Exp Eye Res. 2010;90:437-43 pubmed publisher
    ..The present study suggests that curcumin might have therapeutic potential for treating dry eye disease...
  48. Wang H, Xu J. Should small volume hypertonic saline be used routinely in emergency cardiopulmonary resuscitation?. Resuscitation. 2007;73:162-3 pubmed
  49. Amin R, Subbarao P, Jabar A, Balkovec S, Jensen R, Kerrigan S, et al. Hypertonic saline improves the LCI in paediatric patients with CF with normal lung function. Thorax. 2010;65:379-83 pubmed publisher
    ..Clinical trial number NCT00635141. ..
  50. Krysiak R, Okopień B. [Carbamazepine-induced hyponatremia]. Pol Arch Med Wewn. 2007;117:73-5 pubmed
    ..Our study shows that routine assessment of blood electrolytes is reasonable not only in patients receiving diuretics but also in patients treated with other drugs affecting vasopressin secretion. ..
  51. Haas T, Fries D, Holz C, Innerhofer P, Streif W, Klingler A, et al. Less impairment of hemostasis and reduced blood loss in pigs after resuscitation from hemorrhagic shock using the small-volume concept with hypertonic saline/hydroxyethyl starch as compared to administration of 4% gelatin or 6% hydroxyethyl starch so. Anesth Analg. 2008;106:1078-86, table of contents pubmed publisher
    ..Resuscitation from hemorrhagic shock with HS-HES 200/0.62 results in less impairment of clot formation when compared with compensation of blood loss by administering 6% HES 130/0.4 or 4% gelatin. ..
  52. Ponzio T, Yue C, Gainer H. An intron-based real-time PCR method for measuring vasopressin gene transcription. J Neurosci Methods. 2007;164:149-54 pubmed
  53. Shabala L, Bowman J, Brown J, Ross T, McMeekin T, Shabala S. Ion transport and osmotic adjustment in Escherichia coli in response to ionic and non-ionic osmotica. Environ Microbiol. 2009;11:137-48 pubmed publisher