• Matthew E Fink.
• Weill Cornell Medical College, Department of Neurology and Neuroscience, 525 East 68th Street, F-610, New York, NY 10065, USA. mfink@med.cornell.edu
• Continuum (Minneap Minn). 2012 Jun 1;18(3):640-54.

Purpose Of ReviewHyperosmolar therapy is one of the core medical treatments for brain edema and intracranial hypertension, but controversy exists regarding the use of the most common agents, mannitol, and hypertonic saline. This article describes the relative merits and adverse effects of these agents using the best available clinical evidence.Recent FindingsMannitol is effective and has been used for decades in the treatment of traumatic brain injury, but it may precipitate acute renal failure if serum osmolarity exceeds 320 mOsm/L. Hypertonic saline appears to be safe, and serum sodium has been elevated to as high as 180 mEq/L in clinical settings without significant neurologic, cardiac, or renal injury. In small comparative trials both agents are effective and no clinically significant difference has been noted, but a properly powered trial has not yet been performed.SummaryBoth mannitol and hypertonic saline are effective and have an acceptable risk profile for use in the treatment of elevated intracranial pressure secondary to brain edema.

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