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Sodium Chloride
Pronunciation
U.S. Brand Names
Generic Available
Synonyms
Pharmacological Index
Use
Pregnancy Risk Factor
Contraindications
Warnings/Precautions
Adverse Reactions
Overdosage/Toxicology
Drug Interactions
Stability
Mechanism of Action
Pharmacodynamics/Kinetics
Usual Dosage
Administration
Monitoring Parameters
Reference Range
Dental Health: Local Anesthetic/Vasoconstrictor Precautions
Dental Health: Effects on Dental Treatment
Patient Information
Nursing Implications
Dosage Forms
References

Pronunciation
(SOW dee um KLOR ide)

U.S. Brand Names
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]

Generic Available

Yes


Synonyms
NaCl; Normal Saline; Salt

Pharmacological Index

Electrolyte Supplement, Oral; Lubricant, Ocular


Use

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


Pregnancy Risk Factor

C


Contraindications

Hypertonic uterus, hypernatremia, fluid retention


Warnings/Precautions

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


Adverse Reactions

1% to 10%:

Endocrine & metabolic: Hypernatremia, dilution of serum electrolytes, overhydration, hypokalemia

Local: Phlebitis

Respiratory: Pulmonary edema

Miscellaneous: Congestive conditions, extravasation


Overdosage/Toxicology

Symptoms of overdose include nausea, vomiting, diarrhea, abdominal cramps, hypocalcemia, hypokalemia, hypernatremia

Hypernatremia is resolved through the use of diuretics and free water replacement


Drug Interactions

Decreased levels of lithium


Stability

Store injection at room temperature; protect from heat and from freezing; use only clear solutions


Mechanism of Action

Principal extracellular cation; functions in fluid and electrolyte balance, osmotic pressure control, and water distribution


Pharmacodynamics/Kinetics

Absorption: Oral, I.V.: Rapid

Distribution: Widely distributed

Elimination: Mainly in urine but also in sweat, tears, and saliva


Usual Dosage

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


Administration

Infuse hypertonic solutions (>NaCl 0.9%) via central line only; maximum rate of administration: 1 mEq/kg/hour


Monitoring Parameters

Serum sodium, potassium, chloride, and bicarbonate levels; I & O, weight


Reference Range

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


Dental Health: Local Anesthetic/Vasoconstrictor Precautions

No information available to require special precautions


Dental Health: Effects on Dental Treatment

No effects or complications reported


Patient Information

Blurred vision is common with ophthalmic ointment; may sting eyes when first applied


Nursing Implications

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


Dosage Forms

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


References

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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