Drugs List

Therapeutic Indications

Uses

Treatment of dehydration and electrolyte depletion.

Solvent and diluent for parenteral formulations of drugs.

Administration

The infusion should be given intravenously.

Small volumes of the injection may be given by other parenteral routes.

Handling

Do not dilute before use.

Incompatibilities

Amiodarone, Amphotericin B, Amsacrine and sodium nitroprusside.

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.

Too rapid correction can induce cerebral oedema.

If infusion is protracted then another vein should be selected after 12-24 hours.

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 due to cardiac failure and renal impairment.

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.

Use with caution in patients with:
Peripheral oedema
Pulmonary oedema
Hypertension
Pre-eclampsia
Hyperchloraemia

Avoid fluid and electrolyte overload in infants and the elderly. In the case of fluid overload and electrolyte imbalance discontinue the infusion and if necessary administer a diuretic.

Do not administer rapidly or for prolonged periods particularly in infants and the elderly.

During fluid therapy, monitor fluid and electrolyte status, blood pressure and volume and concentration of urine output

Do not use unless the solution is clear and free from particles.

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
Nausea
Vomiting
Abdominal cramps
Diarrhoea
Thrombosis
Oedema
Hyperchloraemic acidosis
Thirst
Sweating
Fever
Tachycardia
Hypertension
Renal failure
Headache
Dizziness
Restlessness
Convulsions
Coma
Respiratory arrest
Death
Reduced salivation
Decreased lacrimation

Presentation

Infusion or injection containing sodium chloride 0.9%.

Each litre of solution contains 150mmols sodium ions and 150mmol of chloride ions

Drugs List

Therapeutic Indications

Uses

Treatment of dehydration and electrolyte depletion.

Solvent and diluent for parenteral formulations of drugs.

Dosage

Adults

Elderly

Children

Patients with Renal Impairment

Additional Dosage Information

Administration

The infusion should be given intravenously.

Small volumes of the injection may be given by other parenteral routes.

Handling

Do not dilute before use.

Incompatibilities

Amiodarone, Amphotericin B, Amsacrine and sodium nitroprusside.

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.

Too rapid correction can induce cerebral oedema.

If infusion is protracted then another vein should be selected after 12-24 hours.

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 due to cardiac failure and renal impairment.

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.

Use with caution in patients with:
Peripheral oedema
Pulmonary oedema
Hypertension
Pre-eclampsia
Hyperchloraemia

Avoid fluid and electrolyte overload in infants and the elderly. In the case of fluid overload and electrolyte imbalance discontinue the infusion and if necessary administer a diuretic.

Do not administer rapidly or for prolonged periods particularly in infants and the elderly.

During fluid therapy, monitor fluid and electrolyte status, blood pressure and volume and concentration of urine output

Do not use unless the solution is clear and free from particles.

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

Not applicable.

Side Effects

Hypernatraemia
Nausea
Vomiting
Abdominal cramps
Diarrhoea
Thrombosis
Oedema
Hyperchloraemic acidosis
Thirst
Sweating
Fever
Tachycardia
Hypertension
Renal failure
Headache
Dizziness
Restlessness
Convulsions
Coma
Respiratory arrest
Death
Reduced salivation
Decreased lacrimation

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

Storage requirements vary according to brand.

Further Information

Last Full Review Date: February 2012

Reference Sources

British National Formulary, 62nd Edition (2011) Pharmaceutical Press, London.

BNF for Children (2011-2012) Pharmaceutical Press, London.

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

Summary of Product Characteristics Sodium Chloride Infusion BP 0.9% as Steriflex No. 1 or freeflex. Fresenius Kabi Limited. Revised August 2006.

Summary of Product Characteristics Sodium Chloride 0.9% Intravenous Infusion BP. B. Braun Melsungen AG. Revised September 2014.

Summary of Product Characteristics Sodium Chloride 0.9% Intravenous Infusion. Fresenius Kabi Limited. Revised September 2009.