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.