515: SAFETY AND EFFECTIVENESS OF SODIUM ACETATE FOR INTRACRANIAL PRESSURE MANAGEMENT

Abstract

Introduction: Patients suffering from neurologic injuries with elevated intracranial pressure (ICP) often require pharmacologic management with mannitol or hypertonic sodium chloride. Hypertonic sodium chloride can lead to hyperchloremia, which is associated with increased risk of acute kidney injury and mortality. Alternative treatment strategies are therefore needed; one approach is to transition to hypertonic sodium acetate when patients develop hyperchloremia. Currently, there is a paucity of literature exploring hypertonic sodium acetate for ICP management. The objectives of this study are to describe the safety and effectiveness of hypertonic sodium acetate for ICP management. Methods: This is a retrospective cohort study of patients admitted to Mayo Clinic between 1/1/2010-12/9/2020. Patients who received at least two doses of hypertonic sodium acetate for management of elevated ICP were included. Baseline demographics were collected, and the safety of hypertonic sodium acetate was evaluated by changes in arterial pH, chloride, sodium, and renal function. The effectiveness of sodium acetate was assessed by ICP measurements. Results: Seventeen patients met the inclusion criteria. The median age was 55 years (IQR 47-61), and 59% were male. The most common diagnoses were acute ischemic stroke (29%), intracranial hemorrhage (29%) and traumatic brain injury (29%). The most common dose of sodium acetate was 75ml of 10%, and the median number of doses received was 9. Prior to initiating sodium acetate, the median sodium was 148 mEq (144, 150), median chloride was 113 mmol/L (111, 117), median pH 7.4 (7.4, 7.5), and median creatinine 1.0 mg/dL (0.7, 1.2). Twenty-four hours after transitioning to sodium acetate, the median sodium was 150 mEQ (148, 154) (median Δ 2), median chloride was 112 mmol/L (108, 117) (median Δ -3), median pH 7.5 (7.5, 7.5) (median Δ 0.1), and median creatinine 0.8 mg/dL (0.6, 1.3) (median Δ 0). The median ICP prior to sodium acetate initiation was 12 mmHg (4, 18), and the median ICP 24 hours after sodium acetate initiation was 9 mmHg (IQR 3, 11) (median Δ -3). Conclusions: Our findings suggest that transitioning to hypertonic sodium acetate for ICP management in patients experiencing hyperchloremia from hypertonic sodium chloride may represent a safe and effective alternative.