• A P Sarnaik, K Meert, R Hackbarth, and L Fleischmann.
• Department of Pediatrics, Children's Hospital of Michigan, Detroit 48201.
• Crit. Care Med. 1991 Jun 1;19(6):758-62.

ObjectiveTo study efficacy and safety of hypertonic saline administration in the management of hyponatremic seizures.DesignRetrospective, observational, cross-sectional study with factorial design.SettingIn-patient population in a university hospital.PatientsAll children admitted with serum sodium concentrations less than 125 mmol/L. Sixty-nine episodes of severe hyponatremia in 60 children were reviewed. Forty-one of these children presented with seizures.InterventionsTwenty-five of 41 seizure patients received an iv bolus of 4 to 6 mL/kg body weight of 3% saline. Twenty-eight patients were treated with a benzodiazepine and/or phenobarbital with or without the subsequent administration of hypertonic saline.Measurements And Main ResultsThirteen treatment failures and ten instances of apnea occurred among the 28 patients treated with benzodiazepine/phenobarbital. Administration of hypertonic saline resulted in resolution of seizures and apnea in all cases. Those patients receiving 3% saline had a higher serum sodium increase rate from 0 to 4 hrs than the remaining patients (3.1 +/- 1.3 vs. 1.7 +/- 1.2 mmol/L.hr, p less than .01). None developed subsequent neurologic deterioration or clinical manifestations of osmotic demyelination syndrome.ConclusionTreatment of hyponatremic seizures with routine anticonvulsants may be ineffective and is associated with a considerable incidence of apnea. A rapid increase in the serum sodium concentration by 3 to 5 mmol/L with the use of hypertonic saline is safe and efficacious in managing acute symptomatic hyponatremia.

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