Hypertonic Saline, Electrolytes, and Insulin



Hypertonic saline, insulin and electrolyte replacement are commonly used in the intensive care unit.1-3 Hypertonic saline has several beneficial effects including ­volume-expanding properties, increased cardiac output, and intracranial pressure reduction.4,5 The electrolytes play a pivotal role in maintaining several metabolic functions and processes.1,6 Appropriate glucose management in the critically ill using insulin infusions has been associated with beneficial outcomes.7-9


Renal Replacement Therapy Liver Dysfunction Potassium Phosphate Hypertonic Saline Continuous Renal Replacement Therapy 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


  1. 1.
    Buckley MS, LeBlanc JM, Cawley MJ. Electrolyte disturbances associated with commonly prescribed medications in the intensive care unit. Crit Care Med. 2010;38(6 Suppl):S253-S264.PubMedCrossRefGoogle Scholar
  2. 2.
    Froelich M, Quanhong Ni, Wess C, Ougorets I, Härtl R. Continuous hypertonic saline therapy and the occurrence of complications in neurocritically ill patients. Crit Care Med. 2009;37(4):1433-1441.PubMedCrossRefGoogle Scholar
  3. 3.
    Gunst J, Van den Berghe G. Blood glucose control in the intensive care unit: benefits and risks. Semin Dial. 2010;23:157-162.PubMedCrossRefGoogle Scholar
  4. 4.
    Bhardwaj A, Ulatowski A. Hypertonic saline solutions in brain injury. Curr Opin Crit Care. 2004;10:126-131.PubMedCrossRefGoogle Scholar
  5. 5.
    Strandvik GF. 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.PubMedCrossRefGoogle Scholar
  6. 6.
    Kraft MD, Btaiche IF, Sacks GS, et al. Treatment of electrolyte disorders in adult patients in the intensive care unit. Am J Health Syst Pharm. 2005;62:1663-1682.PubMedCrossRefGoogle Scholar
  7. 7.
    Van den Berghe G, Wouters P, Weekers F, et al. Intensive insulin therapy in critically ill patients. N Engl J Med. 2001;345:1359-1367.PubMedCrossRefGoogle Scholar
  8. 8.
    NICE-SUGAR Study Investigators, Finfer S, Chittock DR, Su S, et al. Intensive versus conventional glucose control in critically ill patients. N Engl J Med. 2009;360:1283-1297.PubMedCrossRefGoogle Scholar
  9. 9.
    Pittas AG, Siegel RD, Lau J. Insulin therapy and in-hospital mortality in critically ill patients: systematic review and meta-analysis of randomized controlled trials. JPEN J Parenter Enteral Nutr. 2006;30:164-172.PubMedCrossRefGoogle Scholar
  10. 10.
    Lacherade JC, Jacqueminet S, Preiser JC. An overview of hypoglycemia in the critically ill. J Diabetes Sci Technol. 2009;3:1242-1249.PubMedGoogle Scholar
  11. 11.
    Hashim MK, Issa D, Ahmad Z, Cappuccio JD, Kouides RW, Sterns RH. Hypertonic saline for hyponatremia: risk of inadvertent overcorrection. Clin J Am Soc Nephrol. 2007;2:1110-1117.CrossRefGoogle Scholar
  12. 12.
    Gahart BL, Nazareno AR. Intravenous Medications: A Handbook for Nurses and Health Professionals. 26th ed. St. Louis: Mosby; 2010.Google Scholar
  13. 13.
    Lacy CF, Armstrong LL, Goldman MP, Lance LL. Drug Information Handbook: A Comprehensive Resource for All Clinicians and Healthcare Professionals. 17th ed. Hudson: Lexi-comp; 2008.Google Scholar
  14. 14.
    Locatelli F, Pontoriero G, Di Filippo S. Electrolyte disorders and substitution fluid in continuous renal replacement therapy. Kidney Int Suppl. 1998;53:S151-S155.CrossRefGoogle Scholar
  15. 15.
    Soupart A, Penninckx R, Stenuit A, Perier O, Decaux G. Treatment of chronic hyponatremia in rats by intravenous saline: comparison of rate versus magnitude of correction. Kidney Int. 1992;41:1662-1667.PubMedCrossRefGoogle Scholar
  16. 16.
    Shrishrimal K, Hart P, Michota F. Managing diabetes in hemodialysis patients: observations and recommendations. Cleve Clin J Med. 2009;76:649-655.CrossRefGoogle Scholar
  17. 17.
    Ahmed Z, Simon B, Choudhury D. Management of diabetes in patients with chronic kidney disease. Postgrad Med. 2009;121:52-60.PubMedCrossRefGoogle Scholar
  18. 18.
    Clement S, Braithwaite SS, Magee MF, et al. Management of diabetes and hyperglycemia in hospitals. Diabetes Care. 2004;27:553-591.PubMedCrossRefGoogle Scholar
  19. 19.
    Van den Berghe G, Wilmer A, Hermans G, et al. Intensive insulin therapy in the medical ICU. N Engl J Med. 2006;354:449-461.PubMedCrossRefGoogle Scholar
  20. 20.
    Brunkhorst FM, Engel C, Bloos F, et al. Intensive insulin therapy and pentastarch resuscitation in severe sepsis. N Engl J Med. 2008;358:125-139.PubMedCrossRefGoogle Scholar
  21. 21.
    Dube L, Granry JC. The therapeutic use of magnesium in anesthesiology, intensive care and emergency medicine: a review. Can J Anaesth. 2003;50:732-746.PubMedCrossRefGoogle Scholar
  22. 22.
    Nanji AA. Drug-induced electrolyte disorders. Drug Intell Clin Pharm. 1983;17:175-185.PubMedGoogle Scholar
  23. 23.
    Dacey MJ. Hypomagnesemic disorders. Crit Care Clin. 2001;17:155-173.PubMedCrossRefGoogle Scholar
  24. 24.
    Stoff JS. Phosphate homeostasis and hypophosphatemia. Am J Med. 1982;72:489-495.PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag London Limited 2011

Authors and Affiliations

  1. 1.Department of PharmacyBanner Good Samaritan Medical CenterPhoenixUSA

Personalised recommendations