Sodium Chloride

Mechanism :

principal cation and anion that helps regulate the serum osmolality, osmotic pressure, fluid and electrolyte balance

Indication :

Dehydration
Hypovolemic shock
Cardiogenic shock
Diabetic ketoacidosis
Nasal dryness and congestion
Acute symptomatic hyponatremia
Asymptomatic chronic hyponatremia
Mucolytic and sputum induction in cystic fibrosis patients
Nutritional supplementation
Increased intracranial pressure
Viral bronchiolitis

Contraindications :

Hypertonic uterus, hypersensitivity to normal saline

Dosing :

Infants, Children, Adolescents:

Non emergent dehydration- 0.9% solution, 20 ml/kg IV bolus over an hour, followed by appropriate rehydration fluids over the next 24-48 hours (Maximum- 1000 ml/bolus).

Hypovolemic shock:

0.9% solution, 20 ml/kg IV bolus over 5-20 minutes (Maximum- 1000 ml/bolus).

Cardiogenic shock:

0.9% solution, 5-10 ml/kg bolus over 10-20 minutes.

Diabetic ketoacidosis with compensated shock:

0.9% solution 10 to 20 ml/kg over an hour.

Acute symptomatic hyponatremia:

Neonates, infants, children, adolescents: 3% sodium chloride - 3-5 ml/kg IV over 20-30 minutes.

Asymptomatic or chronic hyponatremia:

Neonates, infants, children, adolescents: IV 0.9% sodium chloride dose- (desired serum sodium in mEq/L - actual serum sodium in mEq/L) x weight (kg) x 0.6

Oral dose – 1 mEq/kg/dose oral 2 to 4 times daily.

Mucolysis and sputum induction in cystic fibrosis patients:

6 to 17 years: Oral inhalation (7% nebulized solution) 4 ml/dose twice a day.

Nasal congestion and dryness:

Neonates, infants, children, adolescents: 2 spray / 2-6 drops in each nostril.

Nutritional supplementation:

>50 kg – 1 to 2 mEq/kg/day IV in addition to total parenteral nutrition (TPN) or enterally in those not on TPN.

Neonates, children adolescents weighing <50 kg: 2 to 5 mEq/kg/day IV in addition to total parental nutrition (TPN) or enterally in those not on TPN

Increased intracranial pressure:

Infants, children, adolescents: 3% NaCl, 2 to 10ml/kg/dose intermittent IV administered over 5-30 minutes

Viral bronchiolitis:

Oral inhalation dose (3% nebulized solution) – neonates, 1-2 years old – 4ml/dose oral inhalation every 2 hourly for three doses followed by 4 hourly for five doses then every 6 hourly prior to discharge.

Adverse Effect :

Hypotension, edema, chills, hypernatremia, hyponatremia, hyperchloremic metabolic acidosis, central pontine myelinosis, thrombosis, hemolysis,

Interaction :

Benzalkonium chloride – Do not use sodium to dilute the drug as it reduces the antibacterial properties of the drug

Lithium- Changes in sodium levels can affect the lithium excretion

Tolvaptan – Do not administer tolvaptan with hypertonic saline as it can cause rapid correction of the hyponatremia

Lactation :

Not distributed in breast milk

Hepatic Dose :

No adjustments labelled. Use cautiously in patients with hepatic impairment.