Pulmonary, obstetric and electrolyte infusions
Hypertonic saline 3% drip
HTS
Dosing
| Start | Hyponatremia with severe symptoms: 150 mL over 20 minutes, repeated up to twice until Na rises 5 (Europe 2014; US panel 2013: 100 mL over 10 minutes); slow infusion 0.5–1 mL/kg/h (SALSA). Raised ICP: 250 mL or 2.5–5 mL/kg (ENLS), usually over 10–20 minutes; infusions to a sodium goal per protocol |
|---|---|
| Titrate | By sodium: 20 minutes after each hyponatremia bolus and every 4 hours while 3% runs (Europe 2014); every 4–6 hours on ICP protocols, which often aim for 145–155 |
| Maximum | Chronic hyponatremia: a rise of no more than 8 mEq/L in any 24 hours (guideline limits 10–12). ICP: stop at Na 155–160 or chloride 110–115 (NCS 2020). B. Braun label: 100 mL/h and 400 mL a day, which guideline boluses exceed |
| Common bags | 256.5 mEq in 500 mL (0.513 mEq/mL) |
| Dose units | mL/kg/h, mL/h |
Line and administration
- A large peripheral vein is acceptable for 3% in many protocols, with frequent site checks; 7.5% and stronger go central (ENLS)
- High-alert drug: independent double-check and pump limits; 23.4% is a central-line bolus only, never this channel
Watch for
- Overcorrection: a surge of dilute urine means check Na now; reverse with D5W and desmopressin (electrolytes page)
- Osmotic demyelination days after a fast rise, most likely with Na 105 or less, alcohol use, malnutrition, liver disease or low K
- Hyperchloremic acidosis and pulmonary edema; wean long ICP infusions to avoid rebound edema
Hypertonic saline: full drug monographIndications, mechanism, pharmacokinetics, cautions and every dose the app lists.
In the one-pagers
- Neuro: ICP and StrokeEVD care and osmotic therapy: 3% saline: 2.5–5 mL/kg bolus or infusion: Favored in TBI, ICH; sodium every 4–6 h, keep <160
- Electrolyte ImbalancesSodium: correct slowly: Severe symptoms (seizures, coma): 3% saline 100–150 mL over 10–20 min, repeated to raise Na about 5 mEq/L.
- Pediatric Assessment and EmergenciesRespiratory failure: airway, bronchiolitis, croup, asthma, foreign body: Bronchiolitis peaks on days 3–5, and infants under about 2 months or born preterm can present with apnea. Care is superficial suction, oxygen and nasogastric or IV fluids; albuterol, epinephrine, routine steroids, antibiotics and hypertonic saline in the ED are not recommended (AAP 2014; Australasian 2025). High-flow nasal ca
- ARDSDefinitions and phenotypes: The task force's reasons: high-flow oxygen use grew after FLORALI and during COVID-19, and in one COVID cohort 93% of patients intubated after high-flow therapy still met ARDS oxygenation criteria on the ventilator; blood gases are drawn less often; S/F imputes P/F well when SpO₂ ≤97%; and Berlin could not be applied where NIV or ventilators did not exist. They also not
- ECMO EssentialsEvidence and controversies: In cardiogenic shock the randomized evidence is negative. ECLS-SHOCK found no mortality benefit with more than double the moderate-to-severe bleeding (23.4% vs 9.6%) and vascular complications (11.0% vs 3.8%); ECMO-CS agreed, and Zeymer's 2023 individual-patient meta-analysis (4 trials, 567 patients) found nothing. Critics cite 12.5% crossover, LV venting in only 5.8%,
- Hypothermia, Heat Stroke and DrowningHeat illness: types, risks and look-alikes: Exercise-associated hyponatremia: sodium under 135 mEq/L with confusion or seizures after long exertion and a near-normal rectal temperature; give 3% saline in 100 mL boluses, up to 3 at 10-min intervals, and no isotonic or hypotonic IV fluid (WMS 2019 update, via AAFP 2021).
Practice Neuro: ICP and Stroke questions free55 exam-style questions with rationales on the topic where hypertonic saline 3% comes up most. No account or download needed.
Other pulmonary, obstetric and electrolyte infusions
Practice free in your browser2,450+ exam-style questions with rationales. No account, no ads. Also free on the App Store and Google Play.
For education and exam preparation only. Follow your institution’s protocols. Study aid: check every dose against your local protocols and medical direction, the bag label and your pump.