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
Hepatic encephalopathy
Severe or chronic hyponatremia (i.e. Na+ <120mmol/L)
Cerebral salt wasting

Administration Guidelines.

Usual Adult Dosage Range and Route:

Chronic hyponatremia: 30 – 100mL per hour for 12-24 hours based on serum Na + deficit (see formula & precautions below)

Intracranial Hypertension & Hepatic Encephalopathy: infusion rate determined by sodium deficit (see formula below) & clinical presentation

250-300mL bolus dose over 20 minutes can be used for emergent control of increased intracranial pressure (central line required for bolus). Consider 23.4% NaCl and mannitol in emergent situations.

Standard Concentration:

3% (500mL bags supplied by pharmacy)

•  3g NaCl/100mL (15g NaCl/500mL)
•  513mEq/L (~257mEq/500mL)
•  1027mOsm/L (~513mOsm/500mL)

EW Standard

3% (500mL bags supplied by pharmacy)

Special considerations:

•  Central line suggested
•  Large bore vein required
•  3% inhalation solution available (potential med order error)
•  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
•  Check serum Na + (reference range: 135-145 mmol/L) and Osm (reference range: 280-296 mosm/kg) Q6H.
•  In crisis ICH situations, consider 23.4% NaCl administration

Precautions and Side Effects:

•  Pregnancy and Lactation Category: unknown
•  Thrombophlebitis, tissue necrosis if extravasated
•  Crenation
•  Hypotension (infusion rate-related)
•  Central pontine myelinolysis (CPM)
•  For hypovolemic hyponatremia consider the use of isotonic fluids or blood products
•  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 CPM. Monitor electrolytes Q6H.
•  Electrolyte abnormalities: hypernatremia, hypokalemia, hyperchloremia, hyperosmolarity, metabolic acidosis (non-anionic gap)
•  Congestive heart failure and pulmonary edema