Indication

Sodium chloride is the chemical name for salt. Sodium is an electrolyte that regulates the amount of water in your body. Sodium also plays a part in nerve impulses and muscle contractions. Sodium chloride is used to treat or prevent sodium loss caused by dehydration, excessive sweating, or other causes.

3% and 5% Sodium Chloride Injection, USP is a sterile, nonpyrogenic, hypertonic solution for fluid and electrolyte replenishment in single dose containers for intravenous administration. The pH may have been adjusted with hydrochloric acid. It contains no antimicrobial agents.

Salt has long been used for flavoring and for preserving food. It has also been used in tanning, dyeing and bleaching, and the production of pottery, soap, and chlorine. Today, it is widely used in the chemical industry.

Sodium chloride Side Effects

• Fast heartbeat.
• fever.
• hives, itching, or rash.
• hoarseness.
• irritation.
• joint pain, stiffness, or swelling.
• redness of the skin.
• shortness of breath.

1. An electrolyte supplement.
2. 3% Hypertonic NaCl should only be used for Emergency treatment of severe hyponatremia.
3. Expansion of the extracellular fluid compartment in cases of hypovolemia and low blood pressure should be done with 0.9% NaCl (normal saline.)

Table 1

Hypertonic 3% sodium chloride is no longer available & so 30% sodium chloride vials must be used to produce a 3% solution. e.g. to produce 250ml of 3% sodium chloride remove 18mls from a 250ml bag of 0.9% sodium chloride & discard. Then add 18mls of 30% sodium chloride to the remaining 232mls in the bag.

3.1. Sodium chloride 3% – Administer 3% sodium chloride infusion in a range between 0.1 and 1 mL/kg/hr (Class I, Level of Evidence A). 32 A 3 to 5 mL/kg bolus may be given over 30 minutes if more aggressive therapy is desired (Class IIa, Level of Evidence B).

Infusion Site A 3% NaCl solution should be delivered through a CVAD if one is already in place. However, in the absence of a CVAD, several small studies suggest that 3% NaCl can be administered safely via a peripheral vein when urgent treatment is necessary.

Patients in the Neuro ICU are frequently given hypertonic saline for brain injuries when there is significant cerebral edema, elevated intracranial pressure or due to processes that lower Na+. Hyponatremia can worsen cerebral edema and hypernatremia has been shown to lower intracranial pressure.

Infusions of 3% sodium chloride are routinely recommended to be given through central, not peripheral IV lines. This recommendation is based on the theory that since the osmolarity of 3% sodium chloride exceeds 900 mOsm/L, it puts the patient at risk of thrombophlebitis, tissue necrosis, and extravasation reactions.

In such cases, the rapid volume expansion from hypertonic saline infusion can appropriately suppress ADH secretion, effect a water diuresis, and result in a rapid rise in serum sodium concentration.

Hypertonic saline can be administered safely through a peripheral vein in a non-ICU setting.

The volume of hypertonic saline (in ml) required to increase serum Na by 8 meq/l was calculated using the formula: 100 × 8/increment in serum Na observed with 100 ml hypertonic saline. This volume was infused over the next 20 hours.

If you simply need to figure out the mL per hour to infuse, take the total volume in mL, divided by the total time in hours, to equal the mL per hour. For example, if you have 1,000 mL NS to infuse over 8 hours, take 1,000 divided by 8, to equal 125 mL/hr. To calculate the drops per minute, the drop factor is needed.

Current evidence confirms that hypertonic saline is effective in raising blood pressure in hypovolaemic shock (Grade A), and is probably of benefit in non-obstructive cardiogenic shock (Grade C).

Normal saline causes an initial increase in serum sodium concentration because it is hypertonic to the serum of patients with hyponatremia, she explained.

Patients should be given intravenous 5% dextrose for acute hypernatremia or half-normal saline (0.45% sodium chloride) for chronic hypernatremia if unable to tolerate oral water.

In cases of dilutional hyponatremia or water intoxication, there is an increase in the volume of blood fluid which leads to a relative reduction in the concentration of sodium. This can lead to symptoms such as headache, nausea, vomiting, disorientation and frequent urination.

Surprisingly, eating too much salt can have the same effect. When you devour sodium-heavy fare, your kidneys have to work overtime to clear out the extra salt. So you end up peeing more than usual, says Movassaghi.