Korean Journal of Pediatrics 2006;49(12):1275-1281.
Published online December 15, 2006.
Comparison of hypertonic saline treatment in meningitis with cerebral edema
Hyung Su Kim, Hee Ra Kim
Department of Pediatrics, Sanggye Paik Hospital, Inje University, College of Medicine, Seoul, Korea
뇌수막염에서 발생한 뇌부종 치료에서 고장성 식염수 비교
김형수, 김희라
인제대학교 의과대학 상계백병원 소아과
Correspondence: 
Hyung Su Kim, Email: h660216@chol.com
Abstract
Purpose
: Cerebral edema in meningitis is a potentially complication. Hypertonic saline of various concentrations are frequently used to treat cerebral edemas in meningitis. We analyzed the safety and efficacy of osmotic therapy in cerebral edema by comparison of various hypertonic saline concentrations and mannitol.
Methods
: The medical records of 42 patients, who were followed up in the Department of Pediatrics, Busan Medical Center, from Jan. 2002 to Oct. 2005, were analyzed retrospectively. We measured intracranial pressure, mean flow velocity, and various laboratory parameters.
Results
: In cerebral edema developed in meningitis, intracranial pressure and symptoms were improved in treatment of hypertonic saline and mannitol. Serial bolus infusion of 3 percent hypertonic saline resulted in the best outcome. There was not a statistically considerable difference on the mean values of the intracranial pressure gap. On transcranial doppler, mean flow velocity was increased and pulsatilty index was decreased. Laboratory findings (osmolarity, Na, Cl, pH, lactic acid, Ca) were diffenent during the treatment period as opposed to K, Hb, bicarbonate, base excess. There was not a specific form of hypertonic saline used in meningitis treatment with cerebral edema.
Conclusion
: The therapy for cerebral edema in meningitis remains largely empirical. Serial bolus infusion of 3 percent hypertonic saline is better than other hypertonic salines. Various concentrations and different infusion methods of hypertonic saline statistically does not influence the result of treatment. More research aimed at improving cerebral edema treatment is needed to identify new, effective forms of treatment.
Key Words: Meningitis, Cerebral Edema, Hypertonic Saline


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