Muro 128

All Other Respiratory Agents for Reactive and Obstructive Airway Diseases
Artificial Tears and Ocular Lubricants
Emollients and Protectants, Other
General Skin Cleansers
Irrigation Solutions, Saline
Mucolytics
Nasal Saline
Other Topical Nasal Agents
Saline Rinse
Sodium Chloride Solutions
Sodium Supplements (new)
Vaginal Douches

May administer without regard to meals.

Sodium chloride injection solution may be administered enterally if necessary.
In general, hypertonic solutions should be utilized to minimize volume. If a 23.4% solution is used, dilute in feedings or water prior to administration.

Visually inspect parenteral products for particulate matter and discoloration prior to administration whenever solution and container permit. Use of a final filter is recommended during administration of all parenteral solutions when possible.
When administering sodium chloride from flexible plastic containers, do not connect in series, pressurize without fully evacuating the container's residual air, or use a vented intravenous administration set with the vent in the open position. Such use could result in air embolism.

Central line administration is preferred for hypertonic sodium chloride solutions more than 0.9%; however, peripheral administration is acceptable in critically ill patients who require immediate therapy. Central access should be obtained for continued use. Monitor peripheral administration of hypertonic solutions carefully for potential extravasation and local tissue damage.
0.45% Sodium Chloride Injection (without additional additives) is the most hypotonic sodium chloride solution that can be safely administered without risking cell lysis. Additional solutes such as dextrose or other electrolytes (e.g., potassium chloride) can be added to hypotonic sodium chloride solutions to increase their tonicity and make intravenous administration feasible without causing cell lysis.
Do not mix or administer hypotonic or hypertonic sodium chloride injection solutions through the same administration set with whole blood or cellular blood components.
 
IV Push/Bolus
0.9% Isotonic Solution (for emergent fluid resuscitation [e.g., severe hypovolemia or shock])
Administer bolus over 5 to 10 minutes for most patients; however, some patients require slower administration:
Patients with cardiogenic shock or cardiac dysfunction (e.g., calcium channel blocker or beta-blocker overdose): Administer over 10 to 20 minutes.
Premature neonates younger than 30 weeks gestation: Avoid rapid administration; some evidence suggests that rapid administration may increase the risk of intracranial hemorrhage.
3% or 5% Hypertonic Solution (for increased ICP)
Administer over 5 to 20 minutes.
23.4% Hypertonic Solution (for increased ICP)
Administer via central line over 10 to 20 minutes.
 
Intermittent IV Infusion
0.9% Isotonic Solution (for urgent fluid replacement [e.g., dehydration or diabetic ketoacidosis with compensated shock])
Administer bolus over 1 hour.
3% Hypertonic Solution (for Hyponatremia)
Adults: Administer over 10 to 20 minutes.
Pediatrics: Administer over 20 to 30 minutes.
 
Continuous IV Infusion
3% Hypertonic Solution (for Hyponatremia or increased ICP)
Adults: Usual rates vary from 0.5 to 3 mL/kg/hour or 10 to 150 mL/hour.
Pediatric patients: Usual rates vary from 0.5 to 3 mL/kg/hour.
ASHP Recommended Standard Concentration for Pediatric Continuous Infusion: 0.5 mEq/mL (3%).

Intraosseous Administration
For emergent fluid resuscitation, 0.9% Sodium Chloride Injection may be given via the intraosseous route when IV access is not available.

Inhalation Solution for Nebulization
To minimize or prevent bronchospasm, administer a bronchodilator (e.g., albuterol) 15 to 60 minutes prior to inhalation of hypertonic sodium chloride.
Inhaled hypertonic sodium chloride has been administered via jet and ultrasonic nebulization.

Hold bottle upright. Give short, firm squeezes into each nostril. Do not aspirate nasal contents back into bottle.
Small Children and Infants: Use drops. Put drops in each nostril and have the child remain on their back for 1 to 2 minutes.
Rinse bottle tip with hot water and wipe with a clean towel after each administration.
To avoid contamination and prevent the spread of infection, do not use the bottle dispenser for more than 1 person to prevent the spread of infection.

Ophthalmic solution
Do not use if solution changes color or becomes cloudy.
Apply to affected eye and replace cap after use.
To avoid contamination, do not touch the tip of the dispenser to any surface (e.g., eye, fingertips, countertop); do not use the bottle dispenser for more than 1 person.
Ophthalmic ointment
Do not use if ointment is difficult to dispense or if particles are visible in the product.
Pull down the lower lid of the affected eye
Apply small amount of ointment (approximately 1/4th inch) to the inside of the eyelid.

coma / Early / 0-1.0
seizures / Delayed / 0-1.0
central pontine myelinolysis / Delayed / 0-1.0
bronchospasm / Rapid / Incidence not known
increased intracranial pressure / Early / Incidence not known
renal failure (unspecified) / Delayed / Incidence not known
heart failure / Delayed / Incidence not known
oliguria / Early / Incidence not known
pulmonary edema / Early / Incidence not known
intraventricular hemorrhage / Delayed / Incidence not known
thrombosis / Delayed / Incidence not known
visual impairment / Early / Incidence not known

hemolysis / Early / Incidence not known
hemoptysis / Delayed / Incidence not known
hyperchloremic acidosis / Delayed / Incidence not known
hyponatremia / Delayed / Incidence not known
encephalopathy / Delayed / Incidence not known
sodium retention / Delayed / Incidence not known
hypernatremia / Delayed / Incidence not known
hypokalemia / Delayed / Incidence not known
hepatomegaly / Delayed / Incidence not known
hyperchloremia / Delayed / Incidence not known
edema / Delayed / Incidence not known
dehydration / Delayed / Incidence not known
hypertension / Early / Incidence not known
erythema / Early / Incidence not known
phlebitis / Rapid / Incidence not known
chest pain (unspecified) / Early / Incidence not known
dyspnea / Early / Incidence not known
hypotension / Rapid / Incidence not known
sinus tachycardia / Rapid / Incidence not known
infusion-related reactions / Rapid / Incidence not known

pharyngitis / Delayed / Incidence not known
sneezing / Early / Incidence not known
sinusitis / Delayed / Incidence not known
cough / Delayed / Incidence not known
hoarseness / Early / Incidence not known
anorexia / Delayed / Incidence not known
nausea / Early / Incidence not known
weakness / Early / Incidence not known
urticaria / Rapid / Incidence not known
injection site reaction / Rapid / Incidence not known
fever / Early / Incidence not known
infection / Delayed / Incidence not known
rash / Early / Incidence not known
tremor / Early / Incidence not known
pruritus / Rapid / Incidence not known
chills / Rapid / Incidence not known
flushing / Rapid / Incidence not known
ocular irritation / Rapid / Incidence not known
ocular pain / Early / Incidence not known

4-Way Saline, Adsorbonac, Altamist, Ayr Allergy & Sinus, Ayr Baby Saline, Ayr Saline Nasal, BD Posiflush Normal Saline, BD Posiflush Sterile Field Normal Saline, BD Posiflush SureScrub Normal Saline, Blairex Broncho Saline, Breathe Free Saline, Deep Sea, Entsol, Hyper-Sal, HyperSal, Hypertears, Little Remedies for Noses, Little Remedies Stuffy Nose, Monoject Sodium Chloride, Muro 128, NebuSal, Ocean, Ocean For Kids, PULMOSAL, Rhinaris, Rhinaris Lubricating, Saljet, Saljet Rinse, SaltAire, Sea Soft, Wound Wash, XYNASE, ZARBEE'S Soothing Saline Nasal Mist

Rx, OTC

Sodium and chloride are the primary cation and anion, respectively, of extracellular fluid
Used for many indications, including fluid resuscitation, hyponatremia, increased ICP; given via neb to improve mucus clearance in cystic fibrosis
Potential complications of systemic therapy may result from rapid volume expansion, rapid correction of hyponatremia, and hypotonic fluid administration

1,000 mL IV bolus. Repeat dose and/or titrate as needed to target hemodynamic stability.

30 mL/kg IV or more within the first 3 hours of resuscitation. If further fluid therapy is required, use small repeat boluses guided by stroke volume or cardiac output. Crystalloids are first-line for fluid resuscitation during sepsis; however, guidelines suggest using balanced crystalloids instead of normal saline.

250 mL IV bolus in patients without evidence of fluid overload. Repeat dose and/or titrate as needed to target hemodynamic stability.

15 to 20 mL/kg (or 1,000 to 1,500 mL) IV during the first hour of treatment, then 250 to 500 mL/hour continuous IV infusion. Guide fluid replacement based on hemodynamics, state of hydration, electrolyte concentrations, and urinary output. After the first hour, use 0.9% Sodium Chloride Injection for patients with low corrected sodium, otherwise use 0.45% Sodium Chloride Injection. Correct fluid deficits within 24 to 36 hours with 50% of resuscitation fluid administered during the first 8 to 12 hours. Closely monitor clinical status and serum osmolality in patients with cardiac or renal compromise to avoid fluid overload. Once serum glucose reaches 200 to 250 mg/dL, change to 5% Dextrose and 0.45% Sodium Chloride Injection.  

20 mL/kg IV bolus (Usual Max: 1,000 mL/bolus) over 1 hour, followed by appropriate rehydration fluids over the next 24 to 48 hours.

20 mL/kg IV bolus (Usual Max: 1,000 mL/bolus) over 5 to 20 minutes. Children with septic shock often have a large fluid deficit and may require 40 to 60 mL/kg during the first hour and 200 mL/kg or more during the first 8 hours of therapy. May repeat as needed to restore blood pressure and tissue perfusion.

5 to 10 mL/kg IV bolus over 10 to 20 minutes. Carefully monitor for signs of worsening respiratory status and pulmonary edema. May repeat as needed to restore blood pressure and tissue perfusion.

10 to 20 mL/kg IV bolus (Usual Max: 1,000 mL/bolus) over 1 hour. Thereafter, therapy should be guided by hemodynamic status and serum electrolytes; subsequent fluid replacement should be completed with 0.45% or 0.9% Sodium Chloride Injection over the next 24 to 48 hours.

10 mL/kg IV bolus. Administer over 5 to 10 minutes for near-term neonates; slower administration is recommended for neonates younger than 30 weeks gestation because rapid administration has been associated with intraventricular hemorrhage. May repeat once if significant improvement does not occur; further volume should only be considered in cases of documented large blood loss.[44520] [52326]

250 to 500 mL/hour continuous IV infusion after the first hour of treatment with 0.9% Sodium Chloride Injection for patients with normal corrected serum sodium. Guide fluid replacement based on hemodynamics, state of hydration, electrolyte concentrations, and urinary output. Correct fluid deficits within 24 to 36 hours with 50% of resuscitation fluid administered during the first 8 to 12 hours. Closely monitor clinical status and serum osmolality in patients with cardiac or renal compromise to avoid fluid overload. Once serum glucose reaches 200 to 250 mg/dL, change to 5% Dextrose and 0.45% Sodium Chloride Injection.  

100 to 150 mL IV over 10 to 20 minutes; may repeat dose up to 3 times as needed until target of 4 to 6 mEq/L increase in serum sodium concentration is achieved. Alternatively, 0.5 to 3 mL/kg/hour continuous IV infusion (2 to 3 mL/kg/hour for those with active seizures or signs of brain herniation).  Monitor serum sodium concentrations every 1 to 2 hours during infusion. In general, do not exceed a correction of 10 to 12 mEq/L in the first 24 hours (8 mEq/L for those at high risk for osmotic demyelination syndrome) and 18 mEq/L within 48 hours.

3 to 5 mL/kg IV over 20 to 30 minutes; may repeat dose as needed until target of 4 to 6 mEq/L increase in serum sodium concentration is achieved. On average, 1 mL/kg of 3% sodium chloride raises the serum sodium concentration by 1 mEq/L.   Alternatively, 0.5 to 3 mL/kg/hour continuous IV infusion (2 to 3 mL/kg/hour for those with active seizures or signs of brain herniation).  Monitor serum sodium concentrations every 1 to 2 hours during infusion. In general, do not exceed a correction of 10 to 12 mEq/L in the first 24 hours (8 mEq/L for those at high risk for osmotic demyelination syndrome) and 18 mEq/L within 48 hours.

3 to 5 mL/kg IV over 20 to 30 minutes; may repeat dose as needed until target of 4 to 6 mEq/L increase in serum sodium concentration is achieved. On average, 1 mL/kg of 3% sodium chloride raises the serum sodium concentration by 1 mEq/L.   Alternatively, 0.5 to 3 mL/kg/hour continuous IV infusion (2 to 3 mL/kg/hour for those with active seizures or signs of brain herniation).  Monitor serum sodium concentrations every 1 to 2 hours during infusion. In general, do not exceed a correction of 10 to 12 mEq/L in the first 24 hours (8 mEq/L for those at high risk for osmotic demyelination syndrome) and 18 mEq/L within 48 hours.

Dose (mEq sodium) = [desired serum sodium (mEq/L) - actual serum sodium (mEq/L)] x total body water (TBW), where TBW = lean body weight (kg) x 0.6 (nonelderly male), 0.5 (elderly male or nonelderly female), or 0.45 (elderly female). In general, do not exceed a correction of 10 to 12 mEq/L in the first 24 hours (8 mEq/L for those at high risk for osmotic demyelination syndrome) and 18 mEq/L within 48 hours.

Dose (mEq sodium) = [desired serum sodium (mEq/L) - actual serum sodium (mEq/L)] x weight (kg) x 0.6. In general, do not exceed a correction of 10 to 12 mEq/L in the first 24 hours (8 mEq/L for those at high risk for osmotic demyelination syndrome) and 18 mEq/L within 48 hours.

Dose (mEq sodium) = [desired serum sodium (mEq/L) - actual serum sodium (mEq/L)] x weight (kg) x 0.6. In general, do not exceed a correction of 10 to 12 mEq/L in the first 24 hours (8 mEq/L for those at high risk for osmotic demyelination syndrome) and 18 mEq/L within 48 hours.

1 to 3 g PO 1 to 4 times daily.   Alternatively, the following formula may be used: Dose (mEq sodium) = [desired serum sodium (mEq/L) - actual serum sodium (mEq/L)] x total body water (TBW), where TBW = lean body weight (kg) x 0.6 (nonelderly male), 0.5 (elderly male or nonelderly female), or 0.45 (elderly female). Oral sodium chloride is recommended in combination with a low-dose loop diuretic as second-line treatment after fluid restriction for SIADH.

1 mEq/kg/dose PO 2 to 4 times daily. Alternatively, the following formula may be used: Dose (mEq sodium) = [desired serum sodium (mEq/L) - actual serum sodium (mEq/L)] x weight (kg) x 0.6. Oral sodium chloride is recommended in combination with a low-dose loop diuretic as second-line treatment after fluid restriction for SIADH.

1 mEq/kg/dose PO 2 to 4 times daily. Alternatively, the following formula may be used: Dose (mEq sodium) = [desired serum sodium (mEq/L) - actual serum sodium (mEq/L)] x weight (kg) x 0.6. Oral sodium chloride is recommended in combination with a low-dose loop diuretic as second-line treatment after fluid restriction for SIADH.

4 mL/dose inhaled by nebulizer twice daily. Mucus clearance is dose-dependent for hypertonic saline concentrations up to 7%; lesser concentrations (e.g., 3%) may be considered for persons who do not tolerate the 7% solution.

4 mL/dose inhaled by nebulizer twice daily. Mucus clearance is dose-dependent for hypertonic saline concentrations up to 7%; lesser concentrations (e.g., 3%) may be considered for persons who do not tolerate the 7% solution.

2 to 6 drops in each nostril as needed. For nasal sprays, 2 sprays in each nostril as needed.

2 to 6 drops in each nostril as needed. For nasal sprays, 2 sprays in each nostril as needed. Drops are recommended for infants.

2 to 6 drops in each nostril as needed. Drops are recommended for neonates.

Up to 6 g/day PO in divided doses may be needed in stress situations when excessive sweating is expected (i.e., fever, exercise/sports, hot weather). Most adults will generally get adequate sodium from consuming a high-sodium diet and supplementation is generally only needed in stressful situations.

Up to 6 g/day PO in divided doses may be needed in stress situations when excessive sweating is expected (i.e., fever, exercise/sports, hot weather). Most adolescents will generally get adequate sodium from consuming a high-sodium diet and supplementation is generally only needed in stressful situations.

Up to 4 g/day PO in divided doses may be needed in stress situations when excessive sweating is expected (i.e., fever, exercise/sports, hot weather). Most older children will generally get adequate sodium from consuming a high-sodium diet and supplementation is generally only needed in stressful situations.

1 to 2 mEq/kg/day PO in divided doses; up to 4 mEq/kg/day PO in divided doses may be needed for infants living in hot ambient temperatures, with increased fluid loss due to vomiting, fever, diarrhea, or tachypnea, or with ostomies. Routine supplementation is recommended for all infants.

1 to 2 mEq/kg/day PO in divided doses; up to 4 mEq/kg/day PO in divided doses may be needed for infants living in hot ambient temperatures, with increased fluid loss due to vomiting, fever, diarrhea, or tachypnea, or with ostomies. Routine supplementation is recommended for all infants.

1 to 2 mEq/kg/day IV. Adjust dosage as needed based on serum sodium concentrations.

1 to 2 mEq/kg/day IV. Adjust dosage as needed based on serum sodium concentrations.

2 to 5 mEq/kg/day IV. Adjust dosage as needed based on serum sodium concentrations.

2 to 5 mEq/kg/day IV. Adjust dosage as needed based on serum sodium concentrations.  

Instill 1 to 2 drops onto the affected eye(s) every 3 to 4 hours. Instruct patients to discontinue use and seek medical advice if condition worsens or persists for more than 72 hours.

Apply a small amount of ointment (approximately 1/4 inch) to the inside, lower eyelid of the affected eye(s) every 3 to 4 hours. Instruct patients to discontinue use and seek medical advice if condition worsens or persists for more than 72 hours.

2.5 to 5 mL/kg/dose IV over 5 to 20 minutes; may repeat dose as needed to maintain target ICP, serum osmolarity, and serum sodium concentrations. Avoid prolonged hypernatremia (serum sodium concentrations more than 160 mEq/L).   

2 to 10 mL/kg/dose IV over 5 to 20 minutes; may repeat dose as needed to maintain target ICP, serum osmolarity, and serum sodium concentrations. Avoid prolonged hypernatremia (serum sodium concentrations more than 160 mEq/L).     

2.5 to 5 mL/kg/dose IV over 5 to 20 minutes; may repeat dose as needed to maintain target ICP, serum osmolarity, and serum sodium concentrations. Avoid prolonged hypernatremia (serum sodium concentrations more than 160 mEq/L).

2.5 to 5 mL/kg/dose IV over 5 to 20 minutes; may repeat dose as needed to maintain target ICP, serum osmolarity, and serum sodium concentrations. Avoid prolonged hypernatremia (serum sodium concentrations more than 160 mEq/L).  

NOTE: 23.4% sodium chloride must be administered via a central line and in small (e.g., 30 mL) infusion aliquots.  

30 mL IV over 10 to 20 minutes; may repeat dose as needed to maintain target ICP, serum osmolarity, and serum sodium concentrations. Avoid prolonged hypernatremia (serum sodium concentrations more than 160 mEq/L).  

0.5 mL/kg/dose (Max: 30 mL/dose) IV over 10 to 20 minutes.   Higher doses based on weight bands have also been reported; a protocol used standard doses of 10 mL for patients weighing 10 to 19 kg, 20 mL for patients weighing 20 to 29 kg, and 30 mL for patients weighing 30 kg or more. May repeat dose as needed to maintain target ICP, serum osmolarity, and serum sodium concentrations. Avoid prolonged hypernatremia (serum sodium concentrations more than 160 mEq/L).     

10 to 75 mL/hour continuous IV infusion, initially; titrate dose to maintain target ICP, serum osmolarity, and serum sodium concentrations. Doses as high as 100 to 150 mL/hour continuous IV infusion have been reported. Avoid prolonged hypernatremia (serum sodium concentrations more than 160 mEq/L).   

0.5 to 1 mL/kg/hour continuous IV infusion, initially; titrate dose to maintain target ICP, serum osmolarity, and serum sodium concentrations. Doses as high as 3 mL/kg/hour continuous IV infusion have been reported. Avoid prolonged hypernatremia (serum sodium concentrations more than 160 mEq/L). [64013]   

4 mL/dose via oral inhalation every 2 hours for 3 doses, then every 4 hours for 5 doses, and finally every 6 hours until discharge. To prevent bronchospasm, administer after a bronchodilator (e.g., albuterol). Of note, although the American Academy of Pediatrics states that nebulized hypertonic saline may be administered to children 1 to 23 months of age hospitalized for bronchiolitis, use in the emergency department is not recommended. Evidence suggests hypertonic saline is effective in improving symptoms of non-severe bronchiolitis after 24 hours of use and reducing hospital length of stay when the admission exceeds 3 days. Although data has been contradictory, meta-analysis suggests use in areas where the length of administration is brief (e.g., the emergency department) does not improve short-term outcomes or decrease hospitalization rates.

4 mL/dose via oral inhalation every 2 hours for 3 doses, then every 4 hours for 5 doses, and finally every 6 hours until discharge. To prevent bronchospasm, administer after a bronchodilator (e.g., albuterol). Evidence suggests hypertonic saline is effective in improving symptoms of non-severe bronchiolitis after 24 hours of use and reducing hospital length of stay when the admission exceeds 3 days. Although data has been contradictory, meta-analysis suggests use in areas where the length of administration is brief (e.g., the emergency department) does not improve short-term outcomes or decrease hospitalization rates.

†Indicates off-label use

Specific guidelines for dosage adjustments in hepatic impairment are not available. Carefully consider fluid status in patients with hepatic impairment and hyponatremia.

Dosage should be modified based on clinical response, but no quantitative recommendations are available. Avoid or use systemic therapy with great caution in patients with severe renal impairment. If use is necessary, monitor serum sodium concentrations and renal function carefully to avoid sodium retention.

Benzalkonium Chloride: (Major) Sodium chloride (saline solutions) should not be used to dilute benzalkonium chloride as saline solutions may decrease the antibacterial potency of the antiseptic. Stored tap water should also not be used for dilution since it may contain microorganisms. Resin deionized water may also contain pathogens and it may inactivate benzalkonium chloride.
Benzalkonium Chloride; Benzocaine: (Major) Sodium chloride (saline solutions) should not be used to dilute benzalkonium chloride as saline solutions may decrease the antibacterial potency of the antiseptic. Stored tap water should also not be used for dilution since it may contain microorganisms. Resin deionized water may also contain pathogens and it may inactivate benzalkonium chloride.
Lithium: (Moderate) Moderate to significant dietary sodium changes, or changes in sodium and fluid intake, may affect lithium excretion. Systemic sodium chloride administration may result in increased lithium excretion and therefore, decreased serum lithium concentrations. In addition, high fluid intake may increase lithium excretion. For patients receiving sodium-containing intravenous fluids, symptom control and lithium concentrations should be carefully monitored. It is recommended that patients taking lithium maintain consistent dietary sodium consumption and adequate fluid intake during the initial stabilization period and throughout lithium treatment. Supplemental oral sodium and fluid should be only be administered under careful medical supervision.
Tolvaptan: (Moderate) Coadministration of tolvaptan and hypertonic saline (e.g., 3% NaCl injection solution) is not recommended. The use of hypertonic sodium chloride in combination with tolvaptan may result in a too rapid correction of hyponatremia and increase the risk of osmotic demyelination (i.e., central pontine myelinolysis).

4-Way Saline/Altamist/Ayr Baby Saline/Ayr Saline Nasal/Breathe Free Saline/Deep Sea/Entsol/Ocean/Ocean For Kids/SaltAire/Sea Soft/Sodium Chloride Nasal Sol: 0.65%, 0.74%, 2.1%, 3%
Adsorbonac/Muro 128/Sodium Chloride Ophthalmic Sol: 2%, 5%
Altamist/Ayr Allergy & Sinus/Ayr Baby Saline/Ayr Saline Nasal/Breathe Free Saline/Deep Sea/Little Remedies for Noses/Little Remedies Stuffy Nose/Ocean/Ocean Complete/Ocean For Kids/Rhinaris/Rhinaris Lubricating/Sea Soft/Sodium Chloride/XYNASE/ZARBEE'S Soothing Saline Nasal Mist Nasal Spray: 0.2%, 0.65%, 2.65%
Altamist/Ayr Baby Saline/Ayr Saline Nasal/Breathe Free Saline/Deep Sea/Ocean/Ocean For Kids/Sea Soft/Sodium Chloride Nasal Spray Met: 0.65%
Ayr Saline Nasal Nasal Drops: 0.65%
BD Posiflush Normal Saline/BD Posiflush Sterile Field Normal Saline/BD Posiflush SureScrub Normal Saline/Monoject Sodium Chloride/Sodium Chloride Intravenous Sol: 0.9%, 9%
BD Posiflush Normal Saline/BD Posiflush Sterile Field Normal Saline/BD Posiflush SureScrub Normal Saline/Sodium Chloride/Sodium Chloride, Bacteriostatic Intramuscular Inj Sol: 0.9%, 1mL, 9mg
BD Posiflush Normal Saline/BD Posiflush Sterile Field Normal Saline/BD Posiflush SureScrub Normal Saline/Sodium Chloride/Sodium Chloride, Bacteriostatic Intravenous Inj Sol: 0.45%, 0.9%, 1mL, 9mg
BD Posiflush Normal Saline/BD Posiflush Sterile Field Normal Saline/BD Posiflush SureScrub Normal Saline/Sodium Chloride/Sodium Chloride, Bacteriostatic Subcutaneous Inj Sol: 0.9%, 1mL, 9mg
Blairex Broncho Saline/HyperSal/Hyper-Sal/NebuSal/PULMOSAL/Sodium Chloride Respiratory (Inhalation) Sol: 0.9%, 3%, 3.5%, 6%, 7%, 10%
Entsol Nasal Gel: 1.1%
Hypertears/Muro 128/Sodium Chloride Ophthalmic Ointment: 5%
Saljet/Saljet Rinse/Sodium Chloride Topical Sol: 0.9%
Sodium Chloride Extracorporeal Sol: 0.9%
Sodium Chloride Intravenous Inj Sol Conc: 3%, 5%, 14.6%, 23.4%
Sodium Chloride Intravesical Sol: 0.9%
Sodium Chloride Irrigation Sol: 0.45%, 0.9%
Sodium Chloride Oral Sol: 1mL, 234mg

For hypovolemia, 1,500 mL IV bolus of a 0.9% isotonic solution. For sodium replacement and management of ICP, dosage must be individualized based on serum sodium concentrations and patient requirements.

For hypovolemia, 1,500 mL IV bolus of a 0.9% isotonic solution. For sodium replacement and management of ICP, dosage must be individualized based on serum sodium concentrations and patient requirements.

For hypovolemia, do not exceed 20 mL/kg IV per bolus (Usual Max: 1,000 mL/bolus) of a 0.9% isotonic solution. For sodium replacement and management of ICP, dosage must be individualized based on serum sodium concentrations and patient requirements. For management of ICP, do not exceed 10 mL/kg/dose IV of a 3% hypertonic solution.

For hypovolemia, do not exceed 20 mL/kg IV per bolus (Usual Max: 1,000 mL/bolus) of a 0.9% isotonic solution. For sodium replacement and management of ICP, dosage must be individualized based on serum sodium concentrations and patient requirements. For management of ICP, do not exceed 10 mL/kg/dose IV of a 3% hypertonic solution.

For hypovolemia, do not exceed 20 mL/kg IV per bolus of a 0.9% isotonic solution. For sodium replacement and management of ICP, dosage must be individualized based on serum sodium concentrations and patient requirements. For management of ICP, do not exceed 10 mL/kg/dose IV of a 3% hypertonic solution.

For hypovolemia, do not exceed 10 mL/kg IV per bolus of a 0.9% isotonic solution. For sodium replacement, dosage must be individualized based on serum sodium concentrations and patient requirements.

Sodium is the principle cation of the extracellular fluid, while chloride is the principle anion. Both ions are physiologically important. Sodium functions as the primary osmotic determinant in extracellular fluid regulation and tissue hydration. Additionally, sodium regulates the membrane potential of cells and the active transport of molecules across cell membranes. Chloride is also responsible for maintaining fluid balance, but it is also essential in the maintenance of acid-base balance. Low plasma chloride levels cause an increase in bicarbonate, producing alkalosis. Sodium is a unique electrolyte because, in general, water balance is directly related to its concentration. High sodium concentrations and an increase is plasma osmolality stimulates mechanisms that increase the water content of the body, such as increased thirst and increased antidiuretic hormone (ADH) secretion, which leads to renal conservation of water. During hyponatremia, the decrease in plasma osmolality stops ADH secretion; therefore, renal water excretion leads to an increase in sodium concentration. Although sodium and water balance is usually regulated by osmolality, volume depletion also stimulates thirst and ADH secretion; ADH secretion is triggered even if the patient is hyponatremic.
 
For use as IV fluids:
Isotonic IV fluids have an osmotic pressure that is approximately equal to that of serum (285—295 mOsm/L). Normal saline (0.9% NaCl) has an osmolality of 308 mOsm/L and is considered isotonic. In contrast, 0.45% NaCl (154 mOsm/L) and 0.225% NaCl (77 mOsm/L) are hypotonic. The initial goal of treating dehydration and shock is to restore intravascular volume, which improves perfusion to critical organs. Because 0.9% NaCl is isotonic, administered fluid remains in the extracellular compartment (comprised of interstitial and intravascular spaces) where it helps restore blood volume and supports peripheral perfusion. Hypotonic solutions should not be used for initial fluid resuscitation because a significant portion of the administered fluid distributes outside the intravascular compartment. Hypotonic solutions are sometimes used in patients with high serum osmolarity (e.g., hypernatremia, diabetic ketoacidosis). In addition, hypotonic saline solutions offer a maintenance infusion option with less sodium content, which is desirable in certain patient populations. However, the most hypotonic fluid that can be safely administered without risking cell lysis is 0.45% NaCl (154 mOsm/L). Mixing hypotonic saline solutions with dextrose or other electrolytes increases their tonicity and makes the overall solution approach isotonicity, making it feasible to administer an intravenous infusion with a lower sodium content.
 
For the reduction of increased intracranial pressure:
In patients with head trauma, administration of intravenous hypertonic NaCl (e.g., 3% NaCl) reduces intracranial pressure by creating an osmotic gradient across the blood-brain barrier. Penetration of sodium across the blood-brain-barrier is low, which results in water passively diffusing into the intravascular space. This reduction of fluid with in the cerebral tissue decreases intracranial volume, cerebral edema, and intracranial pressure. Other theoretical benefits involved in the reduction of intracranial pressure include restoration of normal cellular resting membrane potential and cell volume, stimulation of arterial natriuretic peptide release, inhibition of inflammation, and enhancement of cardiac output.
 
To increase hydration of viscous respiratory secretions:
Local application of NaCl to the respiratory epithelium creates an osmotic gradient, allowing water to diffuse onto the airway surface and rehydrate the periciliary fluid. In patients with cystic fibrosis, orally inhaled hypertonic saline (e.g., 6—7% NaCl) has been proposed to increase the hydration of airway secretions, which enhances mucociliary clearance and improves sputum expectoration, reducing the risk of infection and progressive airway destruction. Though the exact mechanism is unknown, osmotic hydration, disruption of mucus strand cross-linking, and reduction of mucosal edema may facilitate such improvement.

Sodium chloride is administered orally, intravenously, via inhalation, intranasally, and topically to the eye. Sodium chloride distributes primarily to extracellular compartments, including plasma and interstitial fluid; sodium is maintained outside the cell via the Na+/K+-ATPase pump, which exchanges intracellular sodium for extracellular potassium. Penetration across the blood-brain barrier is low. Sodium chloride is excreted primarily in the urine, but it is also excreted in sweat and stool. In healthy patients at steady state with minimal sweat losses, sodium excreted in urine is roughly the same as dietary intake. Sweat sodium concentration is increased in children with cystic fibrosis, aldosterone deficiency, or pseudohypoaldosteronism.
 
Affected cytochrome P450 isoenzymes: none

Approximately 98% of sodium chloride is absorbed in the small intestine. The presence of glucose enhances sodium absorption, providing rationale for including glucose and sodium in oral rehydration solutions.

According to the manufacturer, it is not known whether sodium chloride can cause fetal harm or affect reproduction capacity; only administer sodium chloride during pregnancy if it is clearly needed. However, normal saline (0.9% NaCl) has been used for dehydration reversal during pregnancy and are not expected to cause harm when used in the usual manner. Saline nasal preparations and topical solutions are safe for use during pregnancy.

According to the manufacturer, it is not known whether sodium chloride is excreted in human milk. Because 0.9% sodium chloride has equal osmotic pressure to that of the serum, osmosis across cellular membranes is minimal, and the risk of adverse effects during breast-feeding is small with the use of this isotonic solution. Use caution when using sodium chloride bacteriostatic injection, as the benzyl alcohol preservative is associated with the development of metabolic acidosis, kernicterus, and intraventricular hemorrhage in the neonatal population; bacteriostatic injection is contraindicated for direct use in the neonatal population. Consider the benefits of breast-feeding, the risk of potential infant drug exposure, and the risk of an untreated or inadequately treated condition. If a breast-feeding infant experiences an adverse effect related to a maternally ingested drug, healthcare providers are encouraged to report the adverse effect to the FDA.