Sodium Chloride

Pronunciation

U.S. Brand Names

Altamist [OTC]; Ayr® Baby Saline [OTC]; Ayr® Saline [OTC]; Ayr® Saline Mist [OTC]; Breathe Right® Saline [OTC]; Broncho Saline® [OTC]; Entsol® [OTC]; Muro 128® [OTC]; NaSal™ [OTC]; Nasal Moist® [OTC]; Na-Zone® [OTC]; Ocean® [OTC]; Pediamist® [OTC]; Pretz® Irrigation [OTC]; SalineX® [OTC]; SeaMist® [OTC]; Simply Saline™ [OTC]; Wound Wash Saline™ [OTC]

Synonyms

NaCl; Normal Saline; Salt

Generic Available

Yes

Use

Parenteral: Restores sodium ion in patients with restricted oral intake (especially hyponatremia states or low salt syndrome). In general, parenteral saline uses:

Bacteriostatic sodium chloride: Dilution or dissolving drugs for I.M., I.V., or SubQ injections

Concentrated sodium chloride: Additive for parenteral fluid therapy

Hypertonic sodium chloride: For severe hyponatremia and hypochloremia

Hypotonic sodium chloride: Hydrating solution

Normal saline: Restores water/sodium losses

Pharmaceutical aid/diluent for infusion of compatible drug additives

Ophthalmic: Reduces corneal edema

Oral: Restores sodium losses

Inhalation: Restores moisture to pulmonary system; loosens and thins congestion caused by colds or allergies; diluent for bronchodilator solutions that require dilution before inhalation

Intranasal: Restores moisture to nasal membranes

Irrigation: Wound cleansing, irrigation, and flushing

Use - Unlabeled/Investigational

Traumatic brain injury (hypertonic sodium chloride)

Pregnancy Risk Factor

Contraindications

Hypersensitivity to sodium chloride or any component of the formulation; hypertonic uterus, hypernatremia, fluid retention

Warnings/Precautions

Use with caution in patients with CHF, 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. Wound Wash Saline™ is for single-patient use only.

Adverse Reactions

Frequency not defined.

Cardiovascular: Congestive conditions

Endocrine & metabolic: Extravasation, hypervolemia, hypernatremia, dilution of serum electrolytes, overhydration, hypokalemia

Local: Thrombosis, phlebitis, extravasation

Respiratory: Pulmonary edema

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

Compatibility

Stable in dextran 6% in dextrose, dextran 6% in NS, D5LR, D5¹ /4NS, D5¹ /2NS, D5NS, D5W, D10W, LR, ¹ /2NS, NS; variable stability (consult detailed reference) in fat emulsion 10%, mannitol 20%, mannitol 25%

Y-site administration: Compatible: Ciprofloxacin

Compatibility in syringe: Compatible: Cimetidine

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

Excretion: Primarily urine; also sweat, tears, saliva

Dosage

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)]

Children 2 years and Adults:

Intranasal: 2-3 sprays in each nostril as needed

Irrigation: Spray affected area

Children and Adults: Inhalation: Bronchodilator diluent: 1-3 sprays (1-3 mL) to dilute bronchodilator solution in nebulizer prior to administration

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.

negative

Approximate Deficits of Water and Electrolytes in Moderately Severe Dehydration1

Condition	Water (mL/kg)	Sodium (mEq/kg)
Fasting and thirsting	100-120	5-7
Diarrhea
isonatremic	100-120	8-10
hypernatremic	100-120	2-4
hyponatremic	100-120	10-12
Pyloric stenosis	100-120	8-10
Diabetic acidosis	100-120	9-10
¹ 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

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:

Neonates:

Full-term: 133-142 mEq/L

Premature: 132-140 mEq/L

Children 2 months to Adults: 135-145 mEq/L

Patient Education

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

Dental Health: Effects on Dental Treatment

No significant effects or complications reported

Dental Health: Vasoconstrictor/Local Anesthetic Precautions

No information available to require special precautions

Dosage Forms

Gel, intranasal (Nasal Moist®): 0.65% (30 g)

Injection, solution: 0.45% (25 mL, 50 mL, 100 mL, 250 mL, 500 mL, 1000 mL, 1500 mL, 2000 mL); 0.9% (1 mL, 2 mL, 3 mL, 5 mL, 10 mL, 20 mL, 25 mL, 30 mL, 50 mL, 100 mL, 150 mL, 250 mL, 500 mL, 1000 mL); 2.5 % (250 mL); 3% (500 mL); 5% (500 mL)

Injection, solution [preservative free]: 0.9% (2 mL, 3 mL, 5 mL, 10 mL, 20 mL, 50 mL, 100 mL)

Injection, solution, bacteriostatic: 0.9% (10 mL, 20 mL, 30 mL)

Injection, solution, concentrate: 14.6% [2.5 mEq/mL] (20 mL, 40 mL, 250 mL); 23.4% [4 mEq/mL] (30 mL, 50 mL, 100 mL, 200 mL, 250 mL)

Ointment, ophthalmic (Muro-128®): 5% (3.5 g)

Powder, for nasal solution:

Broncho Saline®: 0.9% (90 mL, 240 mL)

Entsol®: 3% (10.5 g)

Solution, for inhalation: 0.45% (3 mL, 5 mL); 0.9% (3 mL, 5 mL, 15 mL); 3% (15 mL); 10% (15 mL)

Solution, intranasal: 0.65% (45 mL)

Altamist: 0.65% (60 mL) [spray]

Ayr® Baby Saline: 0.65% (30 mL) [spray/drops]

Ayr® Saline: 0.65% (50 mL) [drops]

Ayr® Saline Mist: 0.65% (50 mL) [spray]

Breathe Right® Saline: 0.65% (44 mL) [spray]

Entsol® [preservative free]: 3% (100 mL) [spray]

Entsol® Mist: 3% (30 mL) [spray]

Enstol® Single Use [preservative free]: 3% (240 mL) [nasal wash]

Na-Zone®: 0.75% (60 mL) [spray]

N Sal™: 0.65% (15 mL) [drops]; (30 mL) [spray]

Nasal Moist®: 0.65% (15 mL, 45 mL) [spray]

Ocean®: 0.65% (45 mL) [spray/drops]

Pediamist®: 0.5% (15 mL) [spray]

Pretz® Irrigation: 0.75% (240 mL)

SalineX®: 0.4% (15 mL) [drops]; (50 mL) [spray]

SeaMist®: 0.65% (15 mL) [spray]

Simply Saline™: 0.9% (44 mL) [mist]

Solution for irrigation: 0.45% (2000 mL); 0.9% (250 mL, 500 mL, 1000 mL, 1500 mL, 2000 mL, 3000 mL, 4000 mL, 5000 mL)

Wound Wash Saline™: 0.9% (90 mL, 210 mL)

Solution, ophthalmic: 5% (15 mL)

Muro-128®: 2% (15 mL), 5% (15 mL, 30 mL)

Tablet: 1 g

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.

Joint Commission on Accreditation of Healthcare Organizations, "2005 National Patient Safety Goals," available at http://www.jcaho.org/accredited+organizations/patient+safety/05_npsg_guidelines Last accessed October 15, 2004.

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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