Hypertonic saline: Safe therapy for children with acute brain insult in emergency department of low and middle income country

Background:Hypertonic saline (HTS) has been used for some years to treat elevated intracranial pressure in children in high income countries. There is limited safety data from low and middle income countries. Objective: The primary objective of this study was to assess the response and safety of intravenous administration of hypertonic saline in children with acute brain injury presenting to the pediatric emergency department (PED) of Aga Khan University Hospital (AKUH). The secondary outcomes were changes in outcome- predictive physiological parameters. Methods: A retrospective, chart review of children who received intravenous HTS in the pediatric emergency department to treat acute brain injury (ABI). Result: From January 2013 to December 2013, 216 children received intravenous bolus of 3% HTS as part of their initial management in the PED. The median age of the patients was 6.1 years (1 month to 16 years) and a median dose of 5 mL/kg with 98% of doses given via peripheral line between 30 minutes to one hour. Diagnosis included traumatic brain injury in 110 patients (50.9%) and non-traumatic injury 106 (49.1%) including CNS infection (43.4%), intracranial bleeding (7.5%), acute hepatic failure (10.4%), diabetic ketoacidosis with altered mental status (4.7%). Clinical indications included: depressed consciousness (75.5%), seizures (24%) and shock (0.5%). It is safe no adverse events in any child. Significant improvement was observed in heartrate (p= 0.000) and GCS (0.001) after 3% HTS therapy. Conclusions: We found 3% HTS was safe in childrenwith acute brain injury traumatic or non -traumatic brain injury.