The efficacy of hypertonic saline in the treatment of shock and brain injury is currently being evaluated. In this article, the indications and practice implications of administration of hypertonic saline are described.

SA, a 31-year-old man, was brought to the emergency department by paramedics after being found unresponsive near his home. A computed tomographic scan of his head revealed a large left-sided subdural hematoma. SA was taken emergently to the operating room for a craniectomy and clot evacuation. After surgery, he was transferred to the trauma/neurosurgical intensive care unit for management of increased intracranial pressure.

GF, a 43-year-old woman, was brought to the hospital with a severe headache. A computed tomographic scan showed subarachnoid blood, and a cerebral angiogram revealed a ruptured basilar tip aneurysm. Neurosurgeons successfully performed a coil embolization, and GF was transferred to the intensive care...

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