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Intravenous hypertonic saline ‐ the effect of splitting the dose
Author(s) -
TORVINEN P,
HARJU M,
KIVELÄ T
Publication year - 2014
Publication title -
acta ophthalmologica
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.534
H-Index - 87
eISSN - 1755-3768
pISSN - 1755-375X
DOI - 10.1111/j.1755-3768.2014.t019.x
Subject(s) - medicine , acetazolamide , anesthesia , intraocular pressure , glaucoma , hypertonic saline , saline , blood pressure , ophthalmology
Purpose To compare the effect of a single vs. splitted dose of intravenous hypertonic saline (IVHTS) on intraocular pressure (IOP) among patients with open‐angle glaucoma (OAG). Methods In a prospective, randomised, interventional trial, we enrolled OAG patients with an IOP of 22‐34 mmHg. We excluded patients using oral acetazolamide, those with heart or kidney failure, dementia or another systemic condition that notably decreased physical performance. Participants received 23.4% IVHTS trough an antecubital vein at a rate of 1 ml/s. Group 1 received a single dose of 1 mmol/kg, and Group 2 two doses of 0.5 mmol/kg sodium separated by 10 minutes. We measured IOP before IVHTS and repeatedly for 20 minutes after infusion. Results A total of 32 participants (median age 69 years, range 35‐78); 20 patients in Group 1 and 12 in Group 2. The mean baseline IOP was 26.2 (SD, 2.7) mmHg in Group 1, and 25.4 (3.5) mmHg in Group 2 (P=0.15). In both groups, mean IOP was significantly reduced after IVHTS; mean reduction in Group 1 was 7.0 (2.8) mmHg 10 minutes after IVHTS (P<0.001), and 7.6 (2.6) mmHg (P<0.001) at 20 minutes. In group 2, the corresponding mean reductions after the 2nd dose were 8.1 (2.0) mmHg (P<0.001) and 8.2 (1.8) mmHg (P<0.001), respectively. The mean IOP reductions 10 and 20 minutes after IVHTS were comparable for Group 1 and 2 (P=0.24 and P=0.47, respectively). Within 1‐3 minutes of infusion, 16 patients in Group 1 felt pain at the infusion site as compared to 7 patients in Group 2. The 2nd dose in Group 2 induced more pain than the 1st dose according to 8 patients. Conclusion A single dose of 1.0 mmol/kg and two sequential splitted doses of 0.5 mmol/kg of IVHTS reduce IOP comparably. Splitting the dose did not eliminate the pain felt at the infusion site.