Hypertonic Saline to Achieve Hyperdiuresis: A Case Report

Abstract

Diuretic resistance can commonly occur following chronic diuretic use, leading to difficulty in diuresis. We report on a 59-year-old man with worsening dyspnoea and lower limb swelling. Clinical findings, alongside bedside echocardiography and lung ultrasound, were suggestive of acute decompensated heart failure (ADHF). Despite initial success with IV loop diuretic for diuresis, the patient’s urine output started to deteriorate soon after despite high-dose frusemide infusion, sequential nephron blockade and attempts at ultrafiltration. A decision was made to attempt hyperdiuresis using hypertonic saline, which led to marked improvement in clinical haemodynamic and urine output over the coming days. Several studies have investigated the utility of hypertonic saline in ADHF and demonstrated its effectiveness to varying degrees. A definitive mechanism as to how hypertonic saline exerts its beneficial effect remains unknown, although several hypotheses have been proposed. Diuretic resistance remains a major challenge when managing patients with ADHF. In cases of refractory ADHF with limited treatment options, there may be a role for hypertonic saline administration.