DOI
https://doi.org/10.18849/ve.v11i3.743Abstract
PICO Question
In cats with traumatic brain injury, is hypertonic saline more effective than Lactated Ringer’s Solution (LRS), when measuring neurological recovery?
Clinical bottom line
Category of research
Treatment.
Number and type of study designs reviewed
Zero.
Strength of evidence
Zero.
Outcomes reported
Both hypertonic saline and LRS have been successfully used in the management of traumatic brain injuries in cats. There is not enough evidence to recommend one treatment over the other and they should be chosen with consideration of the individual after assessing patient status.
Conclusion
In cats with traumatic brain injury, there is not enough evidence to say that hypertonic saline is more effective than LRS when measuring short-term neurological response with an improved Modified Glasgow Coma Score.
References
Ballocco, I., Evangelisti, M.A., Deiana, R., Cubeddu, F., Parpaglia, M.L.P., Serra, G., Carta, G. & Manunta, M.L. (2019). A pilot study evaluating the effect of mannitol and hypertonic saline solution in the treatment of increased intracranial pressure in 2 cats and 1 dog naturally affected by traumatic brain injury. Journal of Veterinary Emergency and Critical Care. 29(5), 578–584. DOI: https://doi.org/10.1111/vec.12880
Basak, D., Chatterjee, S., Attergrim, J., Sharma, M.R., Soni, K.D., Verma, S., Gerdin Wärnberg, M. & Roy, N. (2023). Glasgow coma scale compared to other trauma scores in discriminating in-hospital mortality of traumatic brain injury patients admitted to urban Indian hospitals: A multicentre prospective cohort study. Injury. 54(1), 93–99. DOI: https://doi.org/10.1016/j.injury.2022.09.035
Byers, C.G. (2017). Fluid Therapy: Options and Rational Selection. Veterinary Clinics of North America: Small Animal Practice. 47(2), 359–371. DOI: https://doi.org/10.1016/j.cvsm.2016.09.007
Cameron, S., Weltman, J.G. & Fletcher, D.J. (2021). The prognostic value of admission point-of-care testing and modified Glasgow Coma Scale score in dogs and cats with traumatic brain injuries (2007–2010): 212 cases. Journal of Veterinary Emergency and Critical Care. 32(1), 75–82. DOI: https://doi.org/10.1111/vec.13108
Conroy, M., O’Neill, D.O., Boag, A., Church, D. & Brodbelt, D. (2018). Epidemiology of road traffic accidents in cats attending emergency-care practices in the UK. Journal of Small Animal Practice 60(3), 146–152. DOI: https://doi.org/10.1111/jsap.12941
DeWitt, D.S., Prough, D.S., Deal, D.D., Vines, S.M & Hoen, H. (1996). Hypertonic saline does not improve cerebral oxygen delivery after head injury and mild haemorrhage in cats. Critical Care Medicine. 24(1), 109–117. DOI: https://doi.org/10.1097/00003246-199601000-00019
Dinallo, S. & Waseem, M. (2023). Cushing Reflex. In: StatPearls, [online]. Available from: https://www.ncbi.nlm.nih.gov/books/NBK549801/ [Accessed: 27 January 2025].
Garosi, L. & Adamantos, S. (2011). Head Trauma in the Cat: 2. Assessment and Management of Traumatic Brain Injury. Journal of Feline Medicine and Surgery. 13(11), 815–823. DOI: https://doi.org/10.1016/j.jfms.2011.09.003
Gharizadeh, N., Ghokazadeh, M., Naseri, A., Dolati, S., Tarighat, F.,& Soleimanpour, H. (2022). Hypertonic saline for traumatic brain injury: a systematic review and meta-analysis. European Journal of Medical Research. 27(254). DOI: https://doi.org/10.1186/s40001-022-00897-4
Her, J., Merbl, Y., Gerken, K., Kim, M., Hofmeister, E., Bacek, L.M., Kuo, K.W. & Yanke, A.B. (2022). Relationship between admission vitals and brain herniation in 32 cats: A retrospective study. Journal of Feline Medicine and Surgery. 24(8), 770–778. DOI: https://doi.org/10.1177/1098612X211048639
Hernon, T., Gurney, M. & Gibson, S. (2018). A retrospective study of feline trauma patients admitted to a referral centre. Journal of Small Animal Practice. 59(4), 243–247. DOI: https://doi.org/10.1111/jsap.12815
Kolata, R.J. (1980). Trauma in Dogs and Cats: An Overview. The Veterinary Clinics of North America: Small Animal Practice. 10(3), 515–522. DOI: https://doi.org/10.1016/s0195-5616(80)50051-3
Krausz, M.M. (1995). Controversies in Shock Research: Hypertonic Resuscitation—Pros and Cons. Shock.3(1), 69–72. DOI: https://doi.org/10.1097/00024382-199501000-00012
Laureno, R. (1983). Central pontine myelinolysis following rapid correction of hyponatremia. Annals of Neurology, 13(3), 232–242. DOI: https://doi.org/10.1002/ana.410130303
Lee, E.L & Grady Bailin, H. (2024). Washing machine-induced trauma and coagulopathy in a kitten. Canadian Veterinary Journal = La Revue vétérinaire canadienne. 65(12), 1222–1227. Available from: https://pubmed.ncbi.nlm.nih.gov/39649736/ [Accessed: 21 September 2026].
Lee, J.A., Huang, C-M. & Hall, K.E (2022). Epidemiology of severe trauma in cats: An ACVECC VetCOT registry study. Journal of Veterinary Emergency and Critical Care. 32(6), 705–713. DOI: https://doi.org/10.1111/vec.13229
Mason, A., Malik, A. & Ginglen, J.G. (2023). Hypertonic Fluids. In: StatPearls, [online]. Available from: https://www.ncbi.nlm.nih.gov/books/NBK542194/ [Accessed: 16 September 2026].
Mathews, R. & Parent, J. (2006). Head trauma. In: K.A. Mathews, eds., Veterinary Emergency and Critical Care Manual. Guelph, Ontario: Lifelearn, 691–701.
Mekonnen, M., Ong, V., Florence, T., Mozaffari, K., Mahgerefteh, N., Rana, S., Duong, C., Plurad, D. & Yang, I. (2022). Hypertonic Saline Treatment in Traumatic Brain Injury: A Systematic Review. World Neurosurgery. 162, 98–110. DOI: https://doi.org/10.1016/j.wneu.2022.03.056
O’Neill, D., Gunn-Moore, D., Sorrell, S., McAuslan, H., Church, D.B., Pegram, C. & Brodbelt, D.C. (2023). Commonly diagnosed disorders in domestic cats in the UK and their associations with sex and age. Journal of Feline Medicine and Surgery. 25(2). DOI: https://doi.org/10.1177/1098612X231155016
Pinto, F.C.G., Capone-Neto, A., Prist, R., Silva, M.R. & Poli-de-Figueiredo, L.F. (2006). Volume Replacement with Lactated Ringer’s or 3% Hypertonic Saline Solution during Combined Experimental Hemorrhagic Shock and Traumatic Brain Injury. Journal of Trauma: Injury, Infection & Critical Care. 60(4), 758–764. DOI: https://doi.org/10.1097/01.ta.0000214581.89316.73
Platt, S.R., Radaelli, S.T. & McDonnell, J.J. (2001). The Prognostic Value of the Modified Glasgow Coma Scale in Head Trauma in Dogs. Journal of Veterinary Internal Medicine. 15(6), 581–584. DOI: https://doi.org/10.1111/j.1939-1676.2001.tb01594.x
Reineke, E. (2022). Shock. In: K.J. Drobatz, E. Reineke, M.F. Costello & W.T.N. Culp, eds. Feline Emergency and Critical Care Medicine, 2nd ed. DOI: https://doi.org/10.1002/9781119565925.ch3
Sande, A. & West, C. (2010). Traumatic brain injury: a review of pathophysiology and management. Journal of Veterinary Emergency and Critical Care. 20(2), 177–190. DOI: https://doi.org/10.1111/j.1476-4431.2010.00527.x
Simma, B., Burger, R., Falk, M., Sacher, P. & Fanconi, S. (1998). A prospective, randomized, and controlled study of fluid management in children with severe head injury: Lactated Ringer’s solution versus hypertonic saline. Critical Care Medicine. 26(7), 1265–1270. DOI: https://doi.org/10.1097/00003246-199807000-00032
Rout, P., Patel, P. & Davis, D. (2025). Crystalloid Solutions in Intravenous Fluid Therapy. In: StatPearls, [online]. Available from: https://www.ncbi.nlm.nih.gov/books/NBK500033/ [Accessed: 13 September 2026].
Tischer, A. & Firth, A. (2017). Is the Use of Hypertonic Saline Effective in Reducing Intracranial Pressure After Traumatic Brain Injury in Dogs? Veterinary Evidence. 2(2). DOI: https://doi.org/10.18849/ve.v2i2.94
Tranmer, B.I., Iacobacci, R.I. & Kindt, G.W. (1989). Effects of crystalloid and colloid infusions on intracranial pressure and computerized electroencephalographic data in dogs with vasogenic brain edema. Neurosurgery. 25(2), 178–179. DOI: https://doi.org/10.1097/00006123-198908000-00004
Wisner, D., Busche, F., Sturm, J., Gaab, M. & Meyer, H. (1989). Traumatic shock and head injury: effects of fluid resuscitation on the brain. The Journal of Surgical Research. 46(1), 49–59. DOI: https://doi.org/10.1016/0022-4804(89)90181-9
Zhuang, J., Shackford, S.R., Schmoker, J.D. & Pietropaoli Jr, J.A. (1995). Colloid infusion after brain injury: effect on intracranial pressure, cerebral blood flow, and oxygen delivery. Critical Care Medicine. 23(1), 140–148. DOI: https://doi.org/10.1097/00003246-199501000-00023
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