VETINUITY
Hypertonic saline is dosed at 4 mL/kg IV for canine intracranial hypertension and 3.3 mL/kg IV over 15 minutes for feline volume expansion.
Per the Vetinuity hypertonic saline dose calculator below, hypertonic saline dosing ranges from 4 mL/kg IV for intracranial hypertension in dogs to 3.3 mL/kg IV over 15 minutes for intravascular volume expansion in cats.
| Indication | Species | Dose | Route and frequency |
|---|---|---|---|
| Intracranial hypertension | Dog | 4 mL/kg | IV Single dose |
| Hemorrhagic shock resuscitation | Dog | 4 mL/kg | IV Single dose |
| Intravascular plasma volume expansion | Cat | 3.3 mL/kg | IV Single dose over 15 minutes |
In dogs, 7.2% hypertonic saline at 4 mL/kg IV provides rapid volume expansion and sustained elevation of plasma sodium and chloride concentrations.
In cats, 5% hypertonic saline at 3.3 mL/kg IV expands plasma volume by 27 to 30% but exhibits a prolonged elimination half-life of 319 minutes.
In dogs with suspected intracranial hypertension, a single IV dose of 7.2% hypertonic saline at 4 mL/kg produces immediate and sustained increases in plasma sodium and chloride concentrations for up to 120 minutes [S3]. Hypertonic saline rapidly expands intravascular volume by drawing water out of the intracellular compartment [S13]. In canine models of hemorrhagic shock, hypertonic saline administration restores hemodynamic stability and tissue oxygenation more rapidly than isotonic crystalloids [S10].
Administration of 5% hypertonic saline at 3.3 mL/kg IV over 15 minutes in cats achieves peak plasma volume expansion of 27 to 30%, demonstrating six times the relative potency of balanced isotonic crystalloids [S7]. Elimination of hypertonic saline in cats is remarkably slow, with a half-life of 319 minutes, reinforcing feline susceptibility to fluid overload [S7]. In cats with traumatic brain injury and hemorrhage, 3.0% hypertonic saline failed to improve cerebral oxygen delivery at 60 and 120 minutes post-resuscitation [S8].
When managing hyponatremia, serum sodium concentration should generally be raised no more than 10 mmol/L over 24 hours to prevent osmotic demyelination syndrome, though rapid increases are indicated when severe neurologic signs occur [S1]. During cardiopulmonary resuscitation, hypertonic saline boluses are indicated for hypovolemic patients to restore preload and provide neuroprotection [S5]. Conversely, hypertonic crystalloid boluses in euvolemic patients in cardiopulmonary arrest can compromise tissue perfusion pressure and reduce organ blood flow [S5].
Vetinuity is a point of care clinical assistant built by Brian Toncray, an emergency veterinarian, to assist clinicians with fluid calculations, treatment options with literature citations, and patient record summaries.
Cyclophosphamide dosing ranges from 10 mg/m2 PO q48h for canine metronomic therapy to 200-250 mg/m2 PO for pulse lymphoma protocols in dogs and cats.
Calcium gluconate is administered intravenously at 14 to 42 mg/kg in dogs and cats to treat acute ionized hypocalcemia and severe hyperkalemia.
L-asparaginase is dosed at 400 IU/kg IM or SQ in dogs and cats for lymphoma protocol induction, rescue, or combination protocols.
Mitoxantrone is dosed at 5 mg/m2 IV q21d in dogs and 2.5 to 6.5 mg/m2 IV q21d in cats for lymphoma, carcinoma, and mesothelioma.
Serum sodium concentration should be increased by no more than 10 mmol/L over a 24-hour period to prevent osmotic demyelination syndrome, unless active neurologic signs necessitate faster correction [S1].
A dose of 3.3 mL/kg IV over 15 minutes achieves 27 to 30% peak plasma volume expansion with an elimination half-life of 319 minutes in healthy conscious cats [S7].
Hypertonic saline boluses are not recommended for euvolemic patients in cardiopulmonary arrest because they decrease tissue perfusion pressure and compromise blood flow [S5].
High intravenous doses of hypertonic saline cause transient increases in alanine aminotransferase, aspartate aminotransferase, and alkaline phosphatase over the first 72 hours without altering renal parameters [S12].
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