Can a normal saline (NS) intravenous (IV) bolus be given to a patient with weakness and headache, and elevated blood pressure (hypertension) of 155/90 mmHg without a known history of hypertension?

Normal Saline Bolus Administration in a Patient with Elevated Blood Pressure

Normal saline intravenous bolus can be safely administered to a patient with weakness and headache with blood pressure of 155/90 mmHg without a known history of hypertension, as this blood pressure level does not constitute a hypertensive emergency requiring immediate blood pressure reduction.

Assessment of Blood Pressure Status

• A blood pressure of 155/90 mmHg without a known history of hypertension is considered elevated but does not meet criteria for a hypertensive emergency requiring immediate intervention 1
• Hypertensive emergency is characterized by severe elevation in blood pressure with evidence of acute end-organ damage, which is not indicated in this clinical scenario 2
• Administering bolus antihypertensive medications for non-emergency elevated blood pressure in the ED is considered inappropriate practice and is discouraged by hypertension experts 2

Benefits of Normal Saline Administration

• Normal saline can be beneficial for patients presenting with weakness and headache as these symptoms may be related to dehydration or other conditions requiring fluid replacement 1
• Intravenous fluid administration provides venous access for medication administration if the patient's condition changes 1
• Normal saline is preferred over lactated Ringer's solution (which might contribute to metabolic acidosis) or dextrose solutions (which rapidly extravasate from intravascular circulation) 1

Recommended Administration Protocol

• For adults with weakness and headache, 1-2 L of normal saline can be administered at a rate of 5-10 mL/kg in the first 5 minutes 1
• Monitor the patient's blood pressure during and after fluid administration to ensure no adverse effects 1
• Observe for clinical improvement in symptoms of weakness and headache 1

Considerations and Precautions

• While large volumes (>500 mL/day for 3-5 consecutive days) of saline may increase blood pressure variability in patients with pre-existing hypertension, a single bolus for acute management is generally safe 3
• Exercise caution in patients with known congestive heart failure or chronic renal disease to prevent volume overload 1
• If the patient has signs of increased intracranial pressure, normal saline is still appropriate, though hypertonic saline would be considered if ICP elevation is confirmed 4, 5

Monitoring Recommendations

• Monitor vital signs, including blood pressure, heart rate, and respiratory rate during fluid administration 1
• Assess for clinical improvement in symptoms of weakness and headache 1
• If blood pressure increases significantly during fluid administration, consider slowing the infusion rate 3

Important Caveats

• If the patient develops signs of a true hypertensive emergency (such as altered mental status, visual changes, or focal neurological deficits), the treatment approach would need to be reconsidered 1, 2
• The presence of headache alone without other neurological symptoms does not necessarily indicate increased intracranial pressure requiring specialized treatment 4
• Avoid rapid administration of large fluid volumes in elderly patients or those with unknown cardiac status 1