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Intracerebral hemorrhage and fluid management
- Isotonic fluids (0.9% saline) are the standard IV fluid for patients with ICH
- The goal for fluid management is to maintain euvolemia with a urine output > 0.5 cc/kg
- Importantly, 0.45% saline and dextrose containing IVFs should be avoided, as they can exacerbate cerebral edema and increase ICP
- Hypertonic saline has become a popular aternative to normal saline in patients with significant perihematomal edema and mass effect
- Goals when using hypertonic saline are to maintain serum osmolality between 300 - 320 mOsm/L and serum sodium between 150 - 155 mEq/L
References
Rincon F, Mayer SA. Clinical review: critical care management of spontaneous intracerebral hemorrhage. Crit Care 2008;12:237.