• Headache
  • Change in neurological status
  • Specific neurological signs
  • Increasing BP, slowing pulse
  • Papilloedema


  • URGENT transfer to a PICU.
  • Elevate head end of bed by 30 degrees( Neck straight)
  • Check Blood glucose.
  • 3% saline (2-5ml/kg over 30 minutes). Maintain serum osmolarity <360 mOsm/L
  • Mannitol 0.25 g/kg to 1 g/kg( Max 12.5gm)┬ástat over 20 min.
  • Hyperventilation (Paco2 between 30-35mm Hg).
  • Restrict IV fluids to 1/2 maintenance and replace deficit over 72 (rather than 24 hours).
  • Consider repeating a dose of Mannitol (0.5 g/kg) after 2 hours
    • Hi Linda
      Well the guidelines do specify 3% as most studies are done with it. It could be risky and dangerous to try otherwise. If I come across any studies with 5% saline, I will keep you updated. Also Mannitol is a safe bet..

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