Is hypertonic saline effective in treating cerebral edema secondary to severe hepatic (liver) encephalopathy?

From the Research

Effectiveness of Hypertonic Saline in Treating Cerebral Edema

• Hypertonic saline has been shown to be effective in reducing cerebral edema in patients with severe hepatic encephalopathy 1, 2, 3, 4, 5
• A randomized controlled trial compared the efficacy of hypertonic saline and mannitol in reducing intracranial pressure in patients with acute liver failure, and found that both agents had comparable efficacy, but hypertonic saline was better in preventing rebound cerebral edema and had lower renal dysfunction 1
• A retrospective analysis of serial CT scans found that bolus administration of 23.4% hypertonic saline decreased brain tissue volume in patients with severe hepatic encephalopathy, consistent with a reduction in cerebral edema 2
• Hypertonic saline has been recommended as a treatment for cerebral edema in patients with fulminant hepatic failure, along with other measures such as mannitol, hypothermia, and sedation 3, 5
• The use of hypertonic saline in treating cerebral edema and intracranial hypertension has been reviewed, and found to have a favorable effect on both systemic hemodynamics and intracranial pressure, with a low frequency of side effects 4

Mechanism of Action

• Hypertonic saline has an osmotic effect on the brain, drawing water out of the brain tissue and reducing cerebral edema 2, 4
• The reduction in intracranial pressure is thought to be caused by a reduction in water content in areas of the brain with intact blood-brain barrier 4

Comparison with Other Treatments

• Hypertonic saline has been compared with mannitol, and found to have comparable efficacy in reducing intracranial pressure, but with a shorter duration of action 1, 4
• Hypertonic saline has been found to be better than mannitol in preventing rebound cerebral edema and had lower renal dysfunction 1