The patient's ICPs improve, and have settled out between 9-14mmHg throughout the day. He requires some alternating boluses of 23.4% NaCl or mannitol for some occasional ICP spikes over the next few days.
On day 5 of admission, he begins having intracranial hypertension again, spiking up to 40mmHg. You bolus with propofol and fentanyl, to no avail. You then push 30mL of 23.4% NaCl, which provides some brief improvement, allowing you to quickly get a non-contrast head CT. Unfortunately, he's now back up to 36mmHg. You review his labs, and note the following: Na 150, K 3.8, Cl 119, HCO3 18, BUN 21, Cr 0.85, glucose 136, sOsm 320.
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