UMEM Educational Pearls

Title: Fluids and ICH

Category: Critical Care

Keywords: intracerebral hemorrhage, normal saline, hypertonic saline (PubMed Search)

Posted: 1/7/2009 by Mike Winters, MBA, MD (Updated: 12/9/2024)
Click here to contact Mike Winters, MBA, MD

Intracerebral hemorrhage and fluid management

  • Isotonic fluids (0.9% saline) are the standard IV fluid for patients with ICH
  • The goal for fluid management is to maintain euvolemia with a urine output > 0.5 cc/kg
  • Importantly, 0.45% saline and dextrose containing IVFs should be avoided, as they can exacerbate cerebral edema and increase ICP
  • Hypertonic saline has become a popular aternative to normal saline in patients with significant perihematomal edema and mass effect
  • Goals when using hypertonic saline are to maintain serum osmolality between 300 - 320 mOsm/L and serum sodium between 150 - 155 mEq/L

References

Rincon F, Mayer SA. Clinical review: critical care management of spontaneous intracerebral hemorrhage. Crit Care 2008;12:237.