Generic Name:

Sodium Chloride 3% (intravenous solution)

Synonyms:

Hypertonic saline, NaCl 3%

Action:

Increases serum Na + and osmolality to decrease intracranial pressure

Indications:

Intracranial hypertension (acute use consider ICU monitoring need)
Hepatic encephalopathy
Hyponatremia
Cerebral salt wasting

Administration Guidelines.

Usual Adult Dosage Range and Route:

Up to 60mL per hour for 12-24 hours based on serum Na + deficit and/or goal Na+ level determined by MD (see formula & precautions below)

Standard Concentration:

3% (500mL bags supplied by pharmacy)each bag contains:  3g NaCl/100mL (15g NaCl/500mL) 513mEq/L (~257mEq/500mL)
  1027mOsm/L (~513mOsm/500mL)

Special considerations:

•  Central line suggested
•  Large bore vein required
• Check serum Na and Osm at least every 6 hours and titrate per physician order to Na goal.

  Solution pH = 5
*  To calculate sodium deficit:Na + deficit = (Desired Na + conc. - Measured Na + conc.) X 0.6*(kg body wt)

(*Use 0.6 for men & children, 0.5 for women, 0.5 for geriatric men, 0.45 for geriatric women; body weight is ACTUAL body weight)

•  To calculate infusion rate determined by sodium deficit:

3% NaCl infusion rate = sodium deficit/12.312 = mL/hour infusion rate over 24 hours 1.2-2.4 mL/kg body weight/hr can raise serum Na + level by 1-2mEq/L/hour

•  Weaning infusion over 24 hours may decrease the risk of rebound edema related to hyponatremia. Continue to check Na every 6 hours up to 24 hours after Na infusion discontinued .

•  Patients should be placed on placed on cardiac monitoring

Precautions and Side Effects:

•  Pregnancy and Lactation Category: unknown
•  Thrombophlebitis, tissue necrosis if extravasated
•  Crenation
•  Hypotension (infusion rate-related)
•  Central pontine myelinolysis (paresis, dysphagia)
•  •  In patients with chronic hyponatremia, serum osmotic changes greater than 8-12 mmol/L/24h (0.33-0.5mEq/L/h) are associated with osmotic demyelination syndrome and Central pontine myelinolysis •  Electrolyte abnormalities: hypernatremia, hypokalemia, hyperchloremia, hyperosmolarity, metabolic acidosis (non-anionic gap)
•  Congestive heart failure and pulmonary edema