The use of 3% hypertonic saline in traumatic brain injury has recently been investigated by many centers and is now included as first tier therapy in the management of decreasing intracranial pressure (ICP) secondary to severe traumatic brain injury in the pediatric population. Its mechanism in ICP reduction lies in its favorable rheologic and osmolar gradient effects; it concomitantly augments intravascular volume and increase mean arterial pressure to provide optimum cerebral perfusion pressure. Again, multiple studies have shown the direct effect of HTS in lowering ICP along with its safety in a pediatric population. HTS has also been used to treat altered mental status in diabetic ketoacidosis.