Drugs List

Administration

For intravenous administration.

The solution is hypertonic.

The rise in plasma-sodium concentration should not exceed 10 mmol/litre in 24 hours.

Contraindications

Hypernatraemia

Precautions and Warnings

Do not use for protracted periods unless there is a heavy and continued loss of electrolytes. In such circumstances the clinician should continue therapy with great caution and with due regard to the patient's electrolyte balance.

Administer potassium supplements to patients deficient in potassium as sodium chloride solutions will increase potassium loss.

Use with caution in patients susceptible to sodium overload including patients with cardiac failure or renal impairment.

Use with caution in patients with:
Acute renal failure
Peripheral oedema
Pulmonary oedema
Hypertension
Toxaemia of pregnancy

Avoid fluid and electrolyte overload in patients who are:
Elderly
Debilitated
Children under 2 years

During fluid therapy, monitor:
Fluid and electrolyte status - Sodium should be monitored every 2- 4 hours when correcting blood sodium levels.
Blood pressure
Volume and concentration of urine output
Clinical state of the patient

Following surgery or severe trauma, patients should be monitored carefully for the first 5 - 6 days as they may be unable to excrete excess sodium.

If hypertonic sodium chloride solution are given too quickly, sudden cardiac arrest, circulatory overload or Central Pontine Myelinolysis may occur.

Pregnancy and Lactation

Pregnancy

Sodium chloride infusion/injection in pregnancy is usually considered safe.

However, caution should be exercised in pre-eclampsia / toxaemia of pregnancy.

The use of all medication in pregnancy should be avoided whenever possible; particularly in the first trimester. Non-drug treatments should also be considered. When essential, a medication with the best safety record over time should be chosen, employing the lowest effective dose for the shortest possible time. Polypharmacy should be avoided. Teratogens taken in the pre-embryonic period, often quoted as lasting until 14-17 days post-conception, are believed to have an all-or-nothing effect. Where drugs have a short half-life, and when the date of conception is certain, this may allow women to be reassured where drug exposure has occurred within this time frame. Further advice may be available from the UK National Teratology Information Service (NTIS) and through ToxBase, available via password on the internet ( www.toxbase.org ) or if this is unavailable at the backup site ( www.toxbasebackup.org ).

Lactation

Sodium chloride infusion/injection in during lactation is usually considered safe.

Neonates, infants born prematurely, those with low birth weight, those with an unstable gastrointestinal function or who have serious illnesses may require special consideration. For any infant, if a drug is prescribed to the nursing mother, it should be at the lowest practical dose and for the shortest time. When drug administration is unavoidable and breastfeeding is to continue, minimisation of exposure of the infant to the drug may sometimes be achieved by timing the maternal doses to just after a feeding episode. Infants exposed to drugs via breast milk should be monitored for unusual signs or symptoms. Interactions between the drug received by the infant from the mother's milk and medication prescribed for the infant should also be considered, for example, when the drug given to the infant may prevent metabolism of the drug received via breast milk.
Specialist advice is available from the UK Drugs in Lactation Advisory Service at https://www.midlandsmedicines.nhs.uk/content.asp?section=6&subsection=17&pageIdx=1

Side Effects

Hypernatraemia
Fluid retention
Nausea
Vomiting
Abdominal cramps
Diarrhoea
Thirst
Salivation changes
Sweating
Fever
Hypertension
Hypotension
Tachycardia
Cerebral oedema
Respiratory arrest
Headache
Dizziness
Restlessness
Irritability
Weakness
Muscle twitch
Rigidity
Convulsions
Coma
Death
Renal failure
Peripheral oedema
Pulmonary oedema
Acidosis
Lachrymation
Thrombosis
Respiratory failure
Somnolence
Confusion
Central pontine myelinolysis
Dehydration

Drugs List

Dosage

Adults

Elderly

Children

Administration

For intravenous administration.

The solution is hypertonic.

The rise in plasma-sodium concentration should not exceed 10 mmol/litre in 24 hours.

Contraindications

Hypernatraemia

Precautions and Warnings

Do not use for protracted periods unless there is a heavy and continued loss of electrolytes. In such circumstances the clinician should continue therapy with great caution and with due regard to the patient's electrolyte balance.

Administer potassium supplements to patients deficient in potassium as sodium chloride solutions will increase potassium loss.

Use with caution in patients susceptible to sodium overload including patients with cardiac failure or renal impairment.

Use with caution in patients with:
Acute renal failure
Peripheral oedema
Pulmonary oedema
Hypertension
Toxaemia of pregnancy

Avoid fluid and electrolyte overload in patients who are:
Elderly
Debilitated
Children under 2 years

During fluid therapy, monitor:
Fluid and electrolyte status - Sodium should be monitored every 2- 4 hours when correcting blood sodium levels.
Blood pressure
Volume and concentration of urine output
Clinical state of the patient

Following surgery or severe trauma, patients should be monitored carefully for the first 5 - 6 days as they may be unable to excrete excess sodium.

If hypertonic sodium chloride solution are given too quickly, sudden cardiac arrest, circulatory overload or Central Pontine Myelinolysis may occur.

Pregnancy and Lactation

Pregnancy

Sodium chloride infusion/injection in pregnancy is usually considered safe.

However, caution should be exercised in pre-eclampsia / toxaemia of pregnancy.

The use of all medication in pregnancy should be avoided whenever possible; particularly in the first trimester. Non-drug treatments should also be considered. When essential, a medication with the best safety record over time should be chosen, employing the lowest effective dose for the shortest possible time. Polypharmacy should be avoided. Teratogens taken in the pre-embryonic period, often quoted as lasting until 14-17 days post-conception, are believed to have an all-or-nothing effect. Where drugs have a short half-life, and when the date of conception is certain, this may allow women to be reassured where drug exposure has occurred within this time frame. Further advice may be available from the UK National Teratology Information Service (NTIS) and through ToxBase, available via password on the internet ( www.toxbase.org ) or if this is unavailable at the backup site ( www.toxbasebackup.org ).

Lactation

Sodium chloride infusion/injection in during lactation is usually considered safe.

Neonates, infants born prematurely, those with low birth weight, those with an unstable gastrointestinal function or who have serious illnesses may require special consideration. For any infant, if a drug is prescribed to the nursing mother, it should be at the lowest practical dose and for the shortest time. When drug administration is unavoidable and breastfeeding is to continue, minimisation of exposure of the infant to the drug may sometimes be achieved by timing the maternal doses to just after a feeding episode. Infants exposed to drugs via breast milk should be monitored for unusual signs or symptoms. Interactions between the drug received by the infant from the mother's milk and medication prescribed for the infant should also be considered, for example, when the drug given to the infant may prevent metabolism of the drug received via breast milk.
Specialist advice is available from the UK Drugs in Lactation Advisory Service at https://www.midlandsmedicines.nhs.uk/content.asp?section=6&subsection=17&pageIdx=1

Effects on Ability to Drive and Operate Machinery

None known.

Side Effects

Hypernatraemia
Fluid retention
Nausea
Vomiting
Abdominal cramps
Diarrhoea
Thirst
Salivation changes
Sweating
Fever
Hypertension
Hypotension
Tachycardia
Cerebral oedema
Respiratory arrest
Headache
Dizziness
Restlessness
Irritability
Weakness
Muscle twitch
Rigidity
Convulsions
Coma
Death
Renal failure
Peripheral oedema
Pulmonary oedema
Acidosis
Lachrymation
Thrombosis
Respiratory failure
Somnolence
Confusion
Central pontine myelinolysis
Dehydration

Overdosage

It is strongly recommended that the UK National Poisons Information Service be consulted on cases of suspected or actual overdose where there is doubt over the degree of risk or about appropriate management.

The following number will direct the caller to the relevant local centre (0844) 892 0111

Information may be obtained if you have access to ToxBase the primary clinical toxicology database of the National Poisons Information Service. This is available via password on the internet ( www.toxbase.org ) or if this is unavailable at the backup site ( www.toxbasebackup.org ).

Shelf Life and Storage

Store at 2 to 25 degrees C

Further Information

Last Full Review Date: July 2012

Reference Sources

British National Formulary, 63rd Edition (2012) Pharmaceutical Press, London.

Martindale: The Complete Drug Reference, 37th edition (2011) ed. Sweetman, S. Pharmaceutical Press, London.

Summary of Product Characteristics Sodium Chloride: 1.8% Intravenous Infusion. Fresenius Kabi. Revised February 2010.

Summary of Product Characteristics Sodium Chloride: 5% Intravenous Infusion. Fresenius Kabi. Revised February 2010.

Summary of Product Characteristics Sodium Chloride: 2.7% Intravenous Infusion. Fresenius Kabi. Revised February 2010.

NPSA - Signal. Risk of Harm from CPM syndrome following rapid correction of sodium.
Available at:https://www.nrls.npsa.nhs.uk/resources/?entryid45=132971
Last revised: February 28, 2012
Last accessed: July 12, 2012