Errors with extemporaneous compounding of buffered hypertonic saline

Abstract

Buffered hypertonic saline (a 1:1 mixture of sodium chloride and sodium acetate or other nonchloride salts) is often used in neurocritical care patients to prevent or treat hyponatremia while also mitigating iatrogenic hyperchloremia. There is variation in the way that buffered saline is compounded in US hospital pharmacies, which can lead to inaccuracies in the concentration and sodium exposure.