The following is a summary of “Early and prolonged continuous hypertonic saline infusion in patients with acute liver failure,” published in the March 2023 issue of the Critical Care by Michel, et al.

An extended continuous infusion of hypertonic saline (HTS) in patients with acute liver failure (ALF): an examination of patient characteristics, physiological changes, and outcomes. Adult patients with ALF were the subjects of retrospective cohort research. Researchers took measurements every 6 hours for the first week, every day until day 30 or hospital release, and every week as reported until day 180 to record clinical, biochemical, and physiological information.

Out of 127 patients, 85 had ongoing HTS. Continuous renal replacement therapy (CRRT) (P<0.001) and mechanical breathing (P<0.001) were both more common in HTS patients than in non-HTS patients. During a median HTS treatment time of 150 hours (IQR: 84-168), a median sodium load of 2,244 (IQR: 979-4610) mmol was administered. As a result, patients with HTS had a median peak sodium concentration of 149 mmol/L, compared to 138 mmol/L in those without HTS (P<0.001). 

The typical infusion rate for sodium was 0.1 mmol/L/h, while the typical weaning rate was 0.1 mmol/L every 6 h. Non-HTS patients had a median pH of 7.35, while HTS patients had a pH of 7.29. Overall survival for HTS patients was 72.9%, while 72.2% for those who did not receive a transplant. Severe hypernatremia or fast changes in blood sodium were not observed in ALF patients throughout the initiation, delivery, or weaning of HTS infusion.