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Pronunciation |
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(SOW
dee um KLOR
ide) |
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U.S. Brand
Names |
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Adsorbonac® Ophthalmic [OTC];
Afrin® Saline Mist [OTC]; AK-NaCl®[OTC]; Ayr® Saline
[OTC]; Breathe Free®[OTC]; Dristan® Saline Spray [OTC];
HuMist® Nasal Mist [OTC]; Muro 128® Ophthalmic [OTC];
Muroptic-5®[OTC]; NaSal™[OTC]; Nasal Moist®[OTC];
Ocean Nasal Mist [OTC]; Pretz®[OTC]; SalineX®[OTC];
SeaMist®[OTC] |
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Generic
Available |
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Yes |
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Synonyms |
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NaCl; Normal Saline; Salt |
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Pharmacological Index |
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Electrolyte Supplement, Oral; Lubricant, Ocular |
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Use |
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Parenteral restoration of sodium ion in patients with restricted oral intake
(especially hyponatremia states or low salt syndrome). In general, parenteral
saline uses:
Hypotonic sodium chloride: Hydrating solution
Hypertonic sodium chloride: For severe hyponatremia and hypochloremia
Bacteriostatic sodium chloride: Dilution or dissolving drugs for
I.M./I.V./S.C. injections
Concentrated sodium chloride: Additive for parenteral fluid therapy
Pharmaceutical aid/diluent for infusion of compatible drug additives
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Pregnancy Risk
Factor |
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C |
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Contraindications |
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Hypertonic uterus, hypernatremia, fluid retention |
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Warnings/Precautions |
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Use with caution in patients with congestive heart failure, renal
insufficiency, liver cirrhosis, hypertension, edema; sodium toxicity is almost
exclusively related to how fast a sodium deficit is corrected; both rate and
magnitude are extremely important; do not use bacteriostatic sodium chloride in
newborns since benzyl alcohol preservatives have been associated with
toxicity |
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Adverse
Reactions |
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1% to 10%:
Endocrine & metabolic: Hypernatremia, dilution of serum electrolytes,
overhydration, hypokalemia
Local: Phlebitis
Respiratory: Pulmonary edema
Miscellaneous: Congestive conditions, extravasation |
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Overdosage/Toxicology |
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Symptoms of overdose include nausea, vomiting, diarrhea, abdominal cramps,
hypocalcemia, hypokalemia, hypernatremia
Hypernatremia is resolved through the use of diuretics and free water
replacement |
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Drug
Interactions |
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Decreased levels of lithium |
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Stability |
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Store injection at room temperature; protect from heat and from freezing; use
only clear solutions |
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Mechanism of
Action |
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Principal extracellular cation; functions in fluid and electrolyte balance,
osmotic pressure control, and water distribution |
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Pharmacodynamics/Kinetics |
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Absorption: Oral, I.V.: Rapid
Distribution: Widely distributed
Elimination: Mainly in urine but also in sweat, tears, and saliva
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Usual Dosage |
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Newborn electrolyte requirement:
Premature: 2-8 mEq/kg/24 hours
Term:
0-48 hours: 0-2 mEq/kg/24 hours
>48 hours: 1-4 mEq/kg/24 hours
Children: I.V.: Hypertonic solutions (>0.9%) should only be used for the
initial treatment of acute serious symptomatic hyponatremia; maintenance: 3-4
mEq/kg/day; maximum: 100-150 mEq/day; dosage varies widely depending on clinical
condition
Replacement: Determined by laboratory determinations mEq
Sodium deficiency (mEq/kg) = [% dehydration (L/kg)/100 x 70 (mEq/L)] + [0.6
(L/kg) x (140 - serum sodium) (mEq/L)]
Nasal: Use as often as needed
Adults:
GU irrigant: 1-3 L/day by intermittent irrigation
Heat cramps: Oral: 0.5-1 g with full glass of water, up to 4.8 g/day
Replacement I.V.: Determined by laboratory determinations mEq
Sodium deficiency (mEq/kg) = [% dehydration (L/kg)/100 x 70 (mEq/L)] + [0.6
(L/kg) x (140 - serum sodium) (mEq/L)]
To correct acute, serious hyponatremia: mEq sodium = [desired sodium (mEq/L)
- actual sodium (mEq/L)] x [0.6 x wt (kg)]; for acute correction use 125 mEq/L
as the desired serum sodium; acutely correct serum sodium in 5 mEq/L/dose
increments; more gradual correction in increments of 10 mEq/L/day is indicated
in the asymptomatic patient
Chloride maintenance electrolyte requirement in parenteral nutrition: 2-4
mEq/kg/24 hours or 25-40 mEq/1000 kcals/24 hours; maximum: 100-150 mEq/24 hours
Sodium maintenance electrolyte requirement in parenteral nutrition: 3-4
mEq/kg/24 hours or 25-40 mEq/1000 kcals/24 hours; maximum: 100-150 mEq/24 hours.
Approximate deficits of water and electrolytes in moderately severe
dehydration*:
Fasting and thirsting: 100-120 mL/kg water; 5-7 mEq/kg sodium
Diarrhea, isonatremic: 100-120 mL/kg water; 8-10 mEq/kg sodium
Diarrhea, hypernatremic: 100-120 mL/kg water; 2-4 mEq/kg sodium
Diarrhea, hyponatremic: 100-120 mL/kg water; 10-12 mEq/kg sodium
Pyloric stenosis: 100-120 mL/kg water; 8-10 mEq/kg sodium
Diabetic acidosis: 100-120 mL/kg water; 9-10 mEq/kg sodium
*A negative deficit indicates total body excess prior to
treatment.
Adapted from Behrman RE, Kleigman RM, Nelson WE, et al, eds, Nelson
Textbook of Pediatrics, 14th ed, WB Saunders Co, 1992.
Ophthalmic:
Ointment: Apply once daily or more often
Solution: Instill 1-2 drops into affected eye(s) every 3-4 hours
Abortifacient: 20% (250 mL) administered by transabdominal intra-amniotic
instillation |
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Administration |
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Infuse hypertonic solutions (>NaCl 0.9%) via central line only; maximum
rate of administration: 1 mEq/kg/hour |
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Monitoring
Parameters |
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Serum sodium, potassium, chloride, and bicarbonate levels; I & O,
weight |
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Reference Range |
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Serum/plasma sodium levels:
Full-term: 133-142 mEq/L
Premature: 132-140 mEq/L
Children greater than or equal to 2 months to Adults: 135-145 mEq/L
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Dental Health: Local
Anesthetic/Vasoconstrictor
Precautions |
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No information available to require special precautions |
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Dental Health:
Effects on Dental Treatment |
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No effects or complications reported |
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Patient
Information |
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Blurred vision is common with ophthalmic ointment; may sting eyes when first
applied |
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Nursing
Implications |
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Bacteriostatic NS should not be used for diluting or reconstituting drugs for
administration in neonates; I.V. infusion of 3% or 5% sodium chloride should not
exceed 100 mL/hour and should be administered in a central line
only |
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Dosage Forms |
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Drops, nasal: 0.9% with dropper
Injection: 0.2% (3 mL); 0.45% (3 mL, 5 mL, 500 mL, 1000 mL); 0.9% (1 mL, 2
mL, 3 mL, 4 mL, 5 mL, 10 mL, 20 mL, 25 mL, 30 mL, 50 mL, 100 mL, 130 mL, 150 mL,
250 mL, 500 mL, 1000 mL); 3% (500 mL); 5% (500 mL); 20% (250 mL); 23.4% (30 mL,
100 mL)
Injection:
Admixtures: 50 mEq (20 mL); 100 mEq (40 mL); 625 mEq (250 mL)
Bacteriostatic: 0.9% (30 mL)
Concentrated: 14.6% (20 mL, 40 mL, 200 mL); 23.4% (10 mL, 20 mL, 30 mL)
Irrigation: 0.45% (500 mL, 1000 mL, 1500 mL); 0.9% (250 mL, 500 mL, 1000 mL,
1500 mL, 2000 mL, 3000 mL, 4000 mL)
Ointment, ophthalmic: 5% (3.5 g)
Solution:
Irrigation: 0.9% (1000 mL, 2000 mL)
Nasal: 0.4% (15 mL, 50 mL); 0.6% (15 mL); 0.65% (20 mL, 45 mL, 50 mL)
Ophthalmic: 2% (15 mL); 5% (15 mL, 30 mL)
Tablet: 650 mg, 1 g, 2.25 g
Tablet:
Enteric coated: 1 g
Slow release: 600 mg |
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References |
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Barer J, Hill LL, Hill RM, et al,
"Fatal Poisoning From Salt Used as an Emetic," Am J Dis Child, 1973,
125:889-90.
Gresham GS and Mashru MK, "Fatal Poisoning With Sodium Chloride," Forensic
Sci Int, 1982, 20:87-8.
Meadow R, "Nonaccidental Salt Poisoning," Arch Dis Child, 1993,
68(4):448-52.
Moder KG and Hurley DL,
"Fatal Hypernatremia From Exogenous Salt Intake: Report of a Case and Review of the Literature,"
Mayo Clin Proc, 1990, 65(12):1587-94.
Smith EJ, and Palevsky S, "Salt Poisoning in a Two-Year-Old Child," Am J
Emerg Med, 1990, 8:571-2. |
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