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تعداد ایتم قابل مشاهده باقیمانده : 4 مورد

Sodium chloride preparations (saline and oral salt tablets): Drug information

Sodium chloride preparations (saline and oral salt tablets): Drug information
(For additional information see "Sodium chloride preparations (saline and oral salt tablets): Patient drug information" and see "Sodium chloride preparations (saline and oral salt tablets): Pediatric drug information")

For abbreviations and symbols that may be used in Lexicomp (show table)
Brand Names: US
  • 4-Way Saline [OTC];
  • Afrin Saline Nasal Mist [OTC];
  • Altachlore [OTC];
  • Altamist Spray [OTC];
  • Atrapro Dermal Spray;
  • Ayr Nasal Mist Allergy/Sinus [OTC];
  • Ayr Saline Nasal Drops [OTC];
  • Ayr Saline Nasal Gel [OTC];
  • Ayr Saline Nasal Neti Rinse [OTC];
  • Ayr Saline Nasal No-Drip [OTC];
  • AYR Saline Nasal Rinse [OTC];
  • Ayr Saline Nasal [OTC];
  • Ayr [OTC];
  • Baby Ayr Saline [OTC];
  • Deep Sea Nasal Spray [OTC];
  • DiaB Klenz [OTC] [DSC];
  • Entsol Nasal [OTC];
  • Humist [OTC] [DSC];
  • HyperSal;
  • Liquivida Hydration [DSC];
  • MicroKlenz Wound Cleanser [OTC] [DSC];
  • Muro 128 [OTC];
  • Na-Zone [OTC] [DSC];
  • Nasal Moist [OTC];
  • Nebusal [DSC];
  • Ocean Complete Sinus Rinse [OTC];
  • Ocean for Kids [OTC];
  • Ocean Nasal Spray [OTC];
  • Ocean Ultra Saline Mist [OTC];
  • Pretz Irrigation [OTC];
  • Pretz Natur Moist Nasal Spray [OTC];
  • Pretz [OTC];
  • PulmoSal [DSC];
  • RadiaKlenz [OTC] [DSC];
  • Remedy 4-in-1 Body Cleanser [OTC] [DSC];
  • Rhinaris [OTC] [DSC];
  • Safe Wash [OTC];
  • Saline Flush ZR [DSC];
  • Saline Mist Spray [OTC];
  • Saljet Rinse [OTC];
  • Saljet [OTC];
  • Sea-Clens Wound Cleanser [OTC] [DSC];
  • Sochlor [OTC] [DSC];
  • SwabFlush Saline Flush [DSC];
  • Ultra-Klenz [OTC];
  • Wound Wash Saline [OTC]
Brand Names: Canada
  • Addipak Sodium Chloride;
  • Aquapak;
  • Ballard Unit Dose;
  • Sodium Chlorure [DSC]
Pharmacologic Category
  • Electrolyte Supplement, Parenteral;
  • Genitourinary Irrigant;
  • Irrigant;
  • Lubricant, Ocular;
  • Sodium Salt
Dosing: Adult

Bronchodilator diluent: Inhalation: 1 to 3 sprays (1 to 3 mL) to dilute bronchodilator solution in nebulizer before administration.

Cystic fibrosis (off-label use): Inhalation: 7% hypertonic saline: 4 mL two times daily (Castellani 2018; Elkins 2006; Elkins 2016). Note: If patients cannot tolerate 7% hypertonic saline, 3% inhaled solution may be used; refer to institutional protocols. Pretreatment with an inhaled bronchodilator is recommended to prevent potential bronchospasm (Castellani 2018; Elkins 2006; Robinson 1997).

Genitourinary irrigant: Irrigation: 1 to 3 L/day by intermittent irrigation.

Hyponatremia:

Note: For the correction of acute (<48 hours) or chronic (≥48 hours or duration unknown) hyponatremia. Goal of initial therapy is to achieve a 24 hour increase in serum sodium concentration by 4 to 6 mEq/L (maximum serum sodium increase: 8 mEq/L in any 24-hour period), which is sufficient to improve most symptoms of hyponatremia. However, if patient is symptomatic (acute or chronic hyponatremia), it is recommended to increase serum sodium by 4 to 6 mEq/L within the first 6 hours, then maintain serum sodium at a constant level for the remainder of the 24-hour period. In chronic severe hyponatremia, overcorrection or too rapid correction increases the risk of iatrogenic osmotic demyelination syndrome (Sterns 2021). Choice of fluid concentration for sodium correction is dependent upon the severity of the hyponatremia; use hypertonic sodium solutions (eg, 3% NaCl) for symptomatic patients; monitor serum sodium closely during therapy (Sterns 2013).The following recommendations are based on use of 3% NaCl:

Acute hyponatremia (serum sodium <130 mEq/L):

Asymptomatic:

Hypertonic saline: 3% NaCl: IV: 50 mL bolus over at least 5 minutes; monitor serum sodium every 1 to 2 hours to assess need for additional treatment. For treatment goals, refer to "Hyponatremia: Note." Note: Some experts withhold hypertonic saline if hyponatremia is autocorrecting due to water diuresis (Sterns 2021).

Symptomatic:

Hypertonic saline: 3% NaCl: IV: 100 mL over 10 minutes; if symptoms persist, may repeat up to a total of 3 doses over a period of 30 minutes; monitor serum sodium hourly to assess need for repeat treatment (Sterns 2021; Verbalis 2013; WMS [Bennett 2020]). Alternatively, some experts recommend 150 mL over 20 minutes up to a total of 2 doses while measuring serum sodium between infusions (ESE/ESICM/ERAEDTA [Spasovski 2014]). For treatment goals, refer to "Hyponatremia: Note."

Chronic hyponatremia (serum sodium <130 mEq/L):

Asymptomatic or mild to moderate symptoms, moderate hyponatremia (serum sodium 120 to 129 mEq/L):

IV: Administration of 3% NaCl is generally not indicated; identify reason for hyponatremia and treat as appropriate (Sterns 2021). For treatment goals, refer to "Hyponatremia: Note."

Asymptomatic or mild to moderate symptoms, severe hyponatremia (serum sodium <120 mEq/L):

Hypertonic saline: 3% NaCl: IV: Initial: 15 to 30 mL/hour with frequent (eg, every 2 to 4 hours) serum sodium monitoring; or alternatively, 1 mL/kg bolus (maximum bolus: 100 mL) over 10 minutes every 6 hours as needed (Sterns 2021). For treatment goals, refer to "Hyponatremia: Note." Note: Consider combination therapy with desmopressin to prevent overcorrection in select patients (eg, high risk of developing osmotic demyelination syndrome) (Sood 2013; Sterns 2021).

Severe symptoms (eg, seizures, obtundation, coma, respiratory arrest) or known intracranial pathology:

Hypertonic saline: 3% NaCl: IV: 100 mL over 10 minutes; if symptoms persist, may repeat up to a total of 3 doses over a period of 30 minutes (Sterns 2021). Alternatively, some experts recommend 150 mL over 20 minutes, up to a total of 2 doses while measuring serum sodium between infusions (ESE/ESICM/ERAEDTA [Spasovski 2014]). For treatment goals, refer to "Hyponatremia: Note."

Intracranial hypertension (refractory) due to various etiologies (eg, subarachnoid hemorrhage, trauma, neoplasm), transtentorial herniation syndromes (off-label use):

IV (via central venous access only): Hypertonic saline: 23.4% NaCl: 15 to 60 mL administered over 2 to 20 minutes (Koenig 2008; Lewandowski-Belfer 2014; Suarez 1998; Ware 2005).

Intraosseous: Hypertonic saline: 23.4% NaCl: 30 mL administered over 3 to 5 minutes; remove intraosseous catheter after 24 hours due to the complication risk with prolonged use (Farrokh 2019; Wang 2019).

Intracranial hypertension (traumatic brain injury) (off-label use): Note: Optimal dose has not been established; due to insufficient evidence, the Brain Trauma Foundation guidelines do not make specific recommendations on the use of hypertonic saline for the treatment of traumatic intracranial hypertension (BTF [Carney 2017]). Clinical trials are small; few are prospective. Some concentrations may not be commercially available; protocols include:

Continuous infusion: IV: Hypertonic saline: 3% NaCl: Initial: 30 to 50 mL/hour; titrate to maintain serum sodium between 145 to 155 mEq/L (Maguigan 2017; Rajajee 2019). May administer 23.4% bolus infusions to treat acute intracranial pressure (ICP) elevations (Rajajee 2019).

Intermittent bolus dosing: Hypertonic saline:

IV (via central venous access only): 23.4% NaCl: 30 mL administered over 2 to 10 minutes as needed to treat acute ICP elevations (Kerwin 2009; Rajajee 2019; Ware 2005).

IV (via central venous access only): 7.5% NaCl: 2 mL/kg administered over 20 minutes when ICP values exceed 25 mm Hg (Vialet 2003).

Intraosseous: 23.4% NaCl: 30 mL administered over 3 to 5 minutes for <24 hours; may be administered prior to administering a 3% NaCl continuous infusion; remove intraosseous catheter after 24 hours due to the complication risk with prolonged use (Farrokh 2019; Wang 2019).

Nasal congestion: Intranasal: 2 to 3 sprays in each nostril as needed.

Ophthalmic:

Ointment: Apply once daily or more often.

Solution: Instill 1 to 2 drops into affected eye(s) every 3 to 4 hours.

Parenteral nutrition:

Chloride maintenance electrolyte requirement: IV: As needed to maintain acid-base balance with parenteral nutrition; use equal amounts of chloride and acetate to maintain balance and adjust ratio based on individual patient needs (Mirtallo 2004).

Sodium maintenance electrolyte requirement: IV: 1 to 2 mEq/kg/24 hours; customize amounts based on individual patient needs (Mirtallo 2004).

Sclerotherapy, lower-extremity venous disease (off-label use):

Note: May mix with local anesthetic to reduce pain during injection. The following concentrations have been recommended based upon size of affected vein (Dietzek 2007; Peterson 2012; Scovell 2019).

IV: Hypertonic saline:

11.7% to 15% NaCl:

Vessel diameter <0.5 mm: 0.25 mL per injection.

Vessel diameter 0.5 to 1 mm: 0.5 mL per injection.

15% to 23.4% NaCl:

Vessel diameter 1 to 3 mm: 0.5 to 1 mL per injection.

Septic shock or sepsis-induced hypoperfusion, fluid resuscitation (off-label use): IV: Normal saline (0.9% NaCl): Initial resuscitation: Minimum of 30 mL/kg to be given within the first 1 hour for hypotension or lactate ≥4 mmol/L. Administer vasopressors during or after fluid resuscitation to maintain a mean arterial pressure ≥65 mmHg; following initial resuscitation, additional fluid administration guided by frequent reassessment of hemodynamic status may be necessary (Levy 2018). Note: Some patients may require more rapid administration and/or greater amount of fluid for complete initial resuscitation (SCCM [Rhodes 2017]).

Subarachnoid hemorrhage with hyponatremia (ie, ≤133 mEq/L or a decrease by ≥ 6 mEq/L over 24 to 48 hours) (off-label use): IV: Hypertonic saline: 3% NaCl: Initial: 20 mL/hour; titrate by increasing rate by 10 to 20 mL/hour to maintain serum sodium between 136 to 140 mEq/L; may also administer concurrently with oral sodium chloride (Woo 2009).

Wound irrigation: Spray affected area.

Dosing: Pediatric

(For additional information see "Sodium chloride preparations (saline and oral salt tablets): Pediatric drug information")

Note: Systemic hypertonic solutions (>0.9%) should only be used for the initial treatment of acute serious symptomatic hyponatremia or increased intracranial pressure.

Normal daily maintenance sodium requirements (ASPEN [Corkins 2015; Mirtallo 2004]):

Note: Consider all sources of sodium when calculating patient needs; daily maintenance sodium requirements can be met with a combination or enteral and parenteral sources (eg, enteral formulas, IV solutions, parenteral nutrition). Maintenance sodium should be incorporated into the patient's maintenance IV fluids; acid/base balance should be considered when selecting a sodium salt; individualize dose based on patient requirements.

Infants and Children ≤50 kg: Oral, IV: 2 to 5 mEq/kg/day.

Children >50 kg and Adolescents: Oral, IV: 1 to 2 mEq/kg/day.

Hyponatremia: Infants, Children, and Adolescents: IV: Note: The choice of saline preparation (eg, 0.9% isotonic solution or 3% hypertonic solution) is based on the presence and severity of symptoms. The use of 3% hypertonic solution is generally limited to symptomatic patients (severe hyponatremia) with neurologic findings (eg, seizures, altered mental status) (ASPEN 2010; ASPEN [Bruno 2020]).

Symptomatic (severe hyponatremia with severe neurologic symptoms): Limited data available; variable regimens reported: 3% hypertonic solution: Bolus IV infusion: 2 to 5 mL/kg over 20 minutes (maximum dose: 150 mL/dose); monitor serum sodium 20 minutes after dose. If necessary, may repeat up to 2 times if severe symptoms continue (ASPEN [Bruno 2020]; Brenkert 2013). Alternatively, dosing can be based on the estimation of the sodium deficit* needed to correct the serum sodium by 4 to 6 mEq/L in the initial 1 to 4 hours of symptom onset. Maximum correction rate: 0.5 mEq/L/hour or 10 mEq/L/24 hours (ASPEN 2010; ASPEN [Bruno 2020]). In cases in which the onset of hyponatremia has been sudden (<24 hours), the rate of correction can match the rate of onset without an mEq/L/hour limit. Note: Continuous infusion of hypertonic saline may be considered, consult institutional policy (ASPEN [Bruno 2020]).

Asymptomatic or mild to moderate symptoms (mild to moderate hyponatremia): Limited data available: Note: Dosing based on estimation of the sodium deficit* with replacement using 0.9 % isotonic solution over 24 to 48 hours. In general, no more than 50% of sodium deficit should be replaced over 12 hours. Maximum correction rate: 8 mEq/24 hours (chronic hyponatremia duration >48 hours) or 10 mEq/24 hours (acute hyponatremia duration <48 hours) (ASPEN 2010; ASPEN [Bruno 2020]).

*Sodium deficit (mEq sodium) = [desired serum sodium (mEq/L) - actual serum sodium (mEq/L)] x 0.6 x wt (kg)

Hypovolemic shock: Infants, Children, and Adolescents: IV: 0.9% isotonic solution: 20 mL/kg/dose; may repeat until blood pressure and markers of cardiac output (eg, capillary refill, heart rate, peripheral pulses) improve or until signs of fluid overload occur; usual requirement is 40 to 60 mL/kg (ACCM [Davis 2017]).

Septic shock: Limited data available: Infants, Children, and Adolescents: IV: 0.9% isotonic solution: 10 to 20 mL/kg/dose; maximum dose: 1,000 mL/dose; repeat every 15 minutes for up to 4 hours (Inwald 2019; PALS [Topjian 2020]).

Cerebral edema, diabetic ketoacidosis: Limited data available: Infants, Children, and Adolescents: 3% hypertonic solution: IV: 2.5 to 5 mL/kg administered over 10 to 15 minutes, can be used as an alternative to mannitol or in those unresponsive to mannitol (Brenkert 2013; ISPAD [Wolfsdorf 2018]).

Increased intracranial pressure (ICP), traumatic brain injury (TBI):

Note: Monitor sodium concentration closely, avoid sustained (>72 hours) serum sodium concentrations >170 mEq/L to avoid thrombocytopenia and anemia and avoid serum sodium concentrations >160 mEq/L to avoid deep vein thrombosis (BTF [Kochanek 2019]).

Bolus: Limited data available; dosing regimens variable: Infants, Children, and Adolescents: 3% hypertonic solution: IV: 2 to 5 mL/kg administered over 10 to 20 minutes (Brenkert 2013; BTF [Kochanek 2019]; Shein 2016).

Continuous IV infusion: Infants, Children, and Adolescents: 3% hypertonic solution: IV infusion: 0.1 to 1 mL/kg/hour titrated to maintain ICP <20 mm Hg (BTF [Kochanek 2019]); monitor serum sodium concentration closely.

Refractory increased intracranial pressure (ICP), traumatic brain injury (TBI): Limited data available: 23.4% hypertonic solution: Infants, Children, and Adolescents: IV: 0.5 mL/kg. Maximum dose: 30 mL/dose. Note: Therapy should not be administered to patients with a serum sodium >155 mEq/L (BTF [Kochanek 2019]).

Bronchiolitis, viral (mild to moderate, inpatient):

Note: Current bronchiolitis guidelines do not recommend hypertonic saline to treat infants in the emergency department; however, it may be administered to hospitalized infants and children (AAP [Ralston 2014].

Infants and Children <18 months: Limited data available, efficacy results variable, optimal dose not defined: Inhalation: 3% solution: 4 mL inhaled every 2 hours for 3 doses followed by every 4 hours for 5 doses and continued every 6 hours until discharge (Kuzik 2007). Other trials using doses of 2 to 4 mL every 6 hours have shown no benefit (Everard 2014; Flores 2016; Morikawa 2018; Silver 2015).

Cystic fibrosis (CF): Children ≥2 years and Adolescents: 7% solution: Inhalation: 4 mL inhaled twice daily; pretreatment with an inhaled bronchodilator is recommended to prevent potential bronchospasm (Amin 2010; Elkins 2006; CFF [Lahiri 2016; Mogayzel 2013]; Rosenfeld 2012; Ratjen 2019). May be considered for use in symptomatic infants <2 years of age (CFF [Borowitz 2009]). Note: Clinically, some CF centers use 3% or 3.5% inhaled solutions if patients cannot tolerate 7%.

Nasal dryness/congestion: Note: Consult product-specific labeling for approved use in pediatric patients; available concentrations vary. Intranasal solution:

Infants, Children, and Adolescents: Intranasal: 2 to 6 drops per nostril as needed. Product concentrations vary; most are a 0.65% to 0.9% solution.

Corneal edema: Infants, Children, and Adolescents: Ophthalmic:

Ophthalmic ointment (5%): Apply small amount (1/4 inch) every 3 to 4 hours as needed.

Ophthalmic solution (5%): Instill 1 to 2 drops into affected eye(s) every 3 to 4 hours as needed.

Dosing: Geriatric

Refer to adult dosing.

Dosage Forms: US

Excipient information presented when available (limited, particularly for generics); consult specific product labeling. [DSC] = Discontinued product

Aerosol Solution, Nasal:

Ocean Complete Sinus Rinse: (177 mL)

Aerosol Solution, Nasal [preservative free]:

Ocean Complete Sinus Rinse: (177 mL) [drug free]

Gel, Nasal:

Ayr Saline Nasal: (14.1 g) [contains aloe barbadensis, brilliant blue fcf (fd&c blue #1), methylparaben, propylparaben, soybean oil]

Ayr Saline Nasal No-Drip: (22 mL) [contains aloe barbadensis, benzalkonium chloride, benzyl alcohol, soybean oil]

Kit, Intravenous:

Liquivida Hydration: 0.9% [DSC]

Liquid, External:

Atrapro Dermal Spray: (236 mL)

DiaB Klenz: (240 mL [DSC])

MicroKlenz Wound Cleanser: (240 mL [DSC])

RadiaKlenz: (240 mL [DSC])

Remedy 4-in-1 Body Cleanser: 0.5% (236 mL [DSC])

Sea-Clens Wound Cleanser: (178 mL [DSC], 355 mL [DSC])

Ultra-Klenz: (240 mL, 360 mL)

Nebulization Solution, Inhalation:

Generic: 0.9% (3 mL)

Nebulization Solution, Inhalation [preservative free]:

HyperSal: 3.5% (4 mL) [latex free]

HyperSal: 7% (4 mL)

Nebusal: 3% (4 mL [DSC]); 6% (4 mL [DSC])

PulmoSal: 7% (4 mL [DSC])

Generic: 0.9% (3 mL, 5 mL, 15 mL); 3% (4 mL, 15 mL); 7% (4 mL); 10% (4 mL, 15 mL)

Ointment, Ophthalmic:

Altachlore: 5% (3.5 g)

Muro 128: 5% (3.5 g)

Generic: 5% (3.5 g)

Packet, Nasal [preservative free]:

Ayr Saline Nasal Neti Rinse: Sodium chloride and sodium bicarbonate (40 ea) [iodine free]

AYR Saline Nasal Rinse: Sodium chloride and sodium bicarbonate (50 ea, 51 ea, 100 ea) [iodine free]

Solution, External:

Saljet: 0.9% (30 mL)

Wound Wash Saline: 0.9% (210 mL)

Solution, External [preservative free]:

Safe Wash: 0.9% (210 mL) [drug free, latex free]

Saljet Rinse: 0.9% (30 mL)

Solution, Injection:

Generic: 0.9% (2 mL, 10 mL, 20 mL, 30 mL, 100 mL); 14.6% (20 mL, 40 mL)

Solution, Injection [preservative free]:

Generic: 0.9% (2 mL, 3 mL [DSC], 5 mL [DSC], 10 mL, 20 mL, 50 mL)

Solution, Intravenous:

SwabFlush Saline Flush: 0.9% (10 mL [DSC])

Generic: 0.45% (25 mL, 50 mL, 100 mL, 250 mL [DSC], 500 mL, 1000 mL); 0.9% (10 mL [DSC], 25 mL, 50 mL, 100 mL, 150 mL [DSC], 250 mL, 500 mL, 1000 mL); 3% (500 mL); 5% (500 mL); 23.4% (30 mL, 100 mL, 200 mL)

Solution, Intravenous [preservative free]:

Saline Flush ZR: 0.9% (2.5 mL [DSC], 5 mL [DSC], 10 mL [DSC]) [latex free]

Generic: 0.45% (50 mL, 100 mL, 250 mL, 500 mL, 1000 mL); 0.9% (1 mL, 2 mL, 2.5 mL, 3 mL, 5 mL, 10 mL, 25 mL, 50 mL, 100 mL, 125 mL, 150 mL, 250 mL, 500 mL, 1000 mL); 3% (500 mL); 23.4% (30 mL [DSC])

Solution, Irrigation:

Generic: 0.9% (100 mL, 120 mL, 250 mL, 500 mL, 1000 mL, 1500 mL, 2000 mL, 3000 mL, 4000 mL, 5000 mL)

Solution, Nasal:

4-Way Saline: (29.6 mL)

Afrin Saline Nasal Mist: 0.65% (30 mL, 45 mL)

Altamist Spray: 0.65% (45 mL, 60 mL)

Ayr: 0.65% (50 mL)

Ayr Nasal Mist Allergy/Sinus: 2.65% (50 mL) [contains benzalkonium chloride]

Ayr Saline Nasal Drops: 0.65% (50 mL)

Baby Ayr Saline: 0.65% (30 mL)

Deep Sea Nasal Spray: 0.65% (44 mL) [contains benzalkonium chloride]

Humist: 0.65% (45 mL [DSC])

Na-Zone: 0.65% (59 mL [DSC])

Nasal Moist: 0.65% (15 mL, 45 mL) [contains benzyl alcohol]

Ocean for Kids: 0.65% (37.5 mL) [alcohol free, drug free; contains benzalkonium chloride]

Ocean for Kids: 0.65% (37.5 mL) [drug free; contains benzalkonium chloride]

Ocean Nasal Spray: 0.65% (44 mL, 45 mL, 66 mL, 104 mL, 480 mL) [contains benzalkonium chloride]

Pretz: (50 mL, 946 mL)

Pretz Irrigation: (237 mL)

Rhinaris: 0.2% (30 mL [DSC]) [contains benzalkonium chloride, propylene glycol]

Saline Mist Spray: 0.65% (44 mL) [contains benzalkonium chloride]

Generic: 0.65% (44 mL, 88 mL)

Solution, Nasal [preservative free]:

Entsol Nasal: 3% (100 mL) [drug free]

Ocean Ultra Saline Mist: (90 mL) [drug free]

Pretz Natur Moist Nasal Spray: (20 mL) [cfc free]

Solution, Ophthalmic:

Altachlore: 5% (15 mL, 30 mL)

Muro 128: 2% (15 mL); 5% (15 mL, 30 mL)

Sochlor: 5% (15 mL [DSC])

Generic: 5% (15 mL)

Solution, Oral:

Generic: 4 mEq/mL (23.4%) (473 mL)

Swab, Nasal:

Ayr Saline Nasal Gel: (20 ea) [contains methylparaben, propylparaben, soybean oil, trolamine (triethanolamine)]

Tablet, Oral:

Generic: 1 g

Generic Equivalent Available: US

May be product dependent

Dosage Forms Considerations

1 g sodium chloride = elemental sodium 393.3 mg = 17.1 mEq sodium = sodium 17.1 mmol

Dosage Forms: Canada

Excipient information presented when available (limited, particularly for generics); consult specific product labeling. [DSC] = Discontinued product

Nebulization Solution, Inhalation:

Addipak Sodium Chloride: 0.9% (3 mL, 5 mL, 15 mL)

Aquapak: 0.9% (150 mL, 760 mL, 1070 mL, 2200 mL)

Generic: 0.9% (15 mL)

Solution, Injection:

Generic: 0.9% (2 mL, 10 mL, 20 mL, 30 mL, 50 mL, 100 mL, 250 mL, 500 mL, 1000 mL); 14.6% ([DSC])

Solution, Intravenous:

Generic: 0.45% (500 mL, 1000 mL); 0.9% (10 mL, 20 mL, 25 mL, 50 mL, 100 mL, 150 mL, 250 mL, 500 mL, 1000 mL); 3% (250 mL, 500 mL); 5% (500 mL); 23.4% (5 mL, 30 mL, 50 mL, 100 mL, 200 mL)

Solution, Irrigation:

Generic: 0.9% (500 mL, 1000 mL, 2000 mL, 3000 mL, 4000 mL)

Administration: Adult

Oral inhalation: Nebulization solution: Compatibility with other medications (eg, budesonide) in nebulizer has been reported; also refer to institution-specific policies (Kamin 2014). Refer to manufacturer's labeling for additional administration information.

Topical: Irrigation solution: Do not warm >66°C (150°F); not for IV use. Wound Wash Saline: Before use, expel a short stream into air to clear nozzle.

Intraosseous: >2% solutions: Based on data in adult patients, intraosseous administration is a reasonable alternative when quick IV access is not feasible (Cadena 2017; Farrokh 2019; Wang 2019).

IV:

>2% solutions: Administration through a central venous line is recommended due to high osmolarity and tonicity (Mortimer 2006). In the absence of a central line and when urgent administration is necessary, 3% solutions may be safely administered through a peripheral venous line (Dillon 2018; Jones 2016; Meng 2018; Mesghali 2019; Perez 2017). Concentrations >3% should be administered via central venous line only (Mortimer 2006; Suarez 1998). Consult individual institutional policies and procedures.

3% solution: Osmolarity: 1027 mOsm/L; sodium content: 513 mEq/L.

Higher concentrations (>1%) are irritants (with vesicant-like properties at higher osmolarities); higher osmolarity is associated with a higher risk. Ensure proper needle or catheter placement prior to and during infusion; avoid extravasation.

Extravasation management: If extravasation occurs, stop infusion immediately and disconnect (leave cannula/needle in place); gently aspirate extravasated solution (do NOT flush the line); initiate hyaluronidase antidote (if indicated); remove needle/cannula; elevate extremity. Apply dry cold compresses (Reynolds 2014).

Hyaluronidase: Intradermal or SubQ: Inject a total of 1 to 1.7 mL (15 units/mL) as 5 separate 0.2 to 0.3 mL injections (using a 25-gauge needle) into area of extravasation at the leading edge in a clockwise manner (Reynolds 2014).

Administration: Pediatric

Inhalation: For nebulization, not for IV administration; studies administering hypertonic saline utilized varying types of nebulizers, including jet and ultrasonic.

Nasal: Spray into 1 nostril while gently occluding other.

Ophthalmic: Apply to affected eye(s); avoid contact of bottle tip with eye or skin.

Oral: Administer with full glass of water.

Parenteral: Central-line administration is preferred for hypertonic saline (>0.9%) if available and/or if infusion is to be continued; peripheral administration may be necessary for initiation of treatment in critical patients; use of peripheral administration should be limited; intraosseous administration may be used if unable to obtain intravenous access (Luu 2011).

Rate of administration:

0.9% isotonic solution: Hypotension, shock:

Neonates: Published data not available; consider slower administration to avoid IVH (Kattwinkel 2010).

Infants, Children, and Adolescents: Administer boluses by IV push or via rapid infusion device (ACCM [Davis 2017]).

3% hypertonic solution:

>2% solutions: Administration through a central venous line is recommended due to high osmolarity and tonicity (Mortimer 2006). In the absence of a central line and when urgent administration is necessary, 3% solutions may be safely administered through a peripheral venous line (Mesghali 2019; Perez 2017). Consult individual institutional policies and procedures.

Cerebral edema, diabetic ketoacidosis (DKA): Bolus doses typically administered over 10 to 15 minutes. Longer infusions of 30 minutes have also been described in patients DKA (Kamat 2003).

Increased intracranial pressure (ICP), traumatic brain injury (TBI): Bolus doses typically administered over 10 to 20 minutes (BTF [Kochanek 2019]; Shein 2016).

Symptomatic hyponatremia, severe: Bolus doses typically administered over 20 minutes (ASPEN [Bruno 2020])

23.4% hypertonic saline: Increased ICP, TBI: Bolus doses typically administered over 10 minutes (BTF [Kochanek 2019]. Note: Concentrations >3% should be administered via central venous line only (Mortimer 2006).

Vesicant at higher concentrations (>1%); ensure proper needle or catheter placement prior to and during infusion; avoid extravasation. If extravasation occurs, stop infusion immediately and disconnect (leave cannula/needle in place); gently aspirate extravasated solution (do NOT flush the line); initiate hyaluronidase antidote if indicated (see Management of Drug Extravasations for more details); remove needle/cannula; elevate extremity. Apply dry cold compresses (Reynolds 2014).

Use: Labeled Indications

Inhalation: Restores moisture to pulmonary system; loosens and thins congestion caused by colds or allergies; diluent for bronchodilator solutions that require dilution before inhalation

Intranasal: Restores moisture to nasal membranes

Irrigation: Wound cleansing, irrigation, and flushing

Ophthalmic: Reduces corneal edema

Parenteral: Restores sodium ion in patients with restricted oral intake (especially hyponatremia states or low salt syndrome).

Concentrated sodium chloride: Additive for parenteral fluid therapy

Hypertonic sodium chloride: For severe hyponatremia and hypochloremia

Hypotonic sodium chloride: Hydrating solution

Normal saline: Restores water/sodium losses

Use: Off-Label: Adult

Cystic fibrosis; Refractory elevated intracranial pressure; Sclerotherapy, lower-extremity venous disease; Septic shock or sepsis-induced hypoperfusion, fluid resuscitation; Subarachnoid hemorrhage; Transtentorial herniation syndrome; Traumatic brain injury with elevated intracranial pressure

Medication Safety Issues
Sound-alike/look-alike issues:

Afrin (saline) may be confused with Afrin (oxymetazoline)

High alert medication:

The Institute for Safe Medication Practices (ISMP) includes this medication (IV formulation >0.9% concentration) among its list of drugs which have a heightened risk of causing significant patient harm when used in error.

Other safety concerns:

Per The Joint Commission (TJC) recommendations, concentrated electrolyte solutions (eg, NaCl >0.9%) should not be available in patient care areas.

Inappropriate use of low sodium or sodium-free intravenous fluids (eg, D5W, hypotonic saline) in pediatric patients can lead to significant morbidity and mortality due to hyponatremia (ISMP 2009).

Adverse Reactions

The following adverse drug reactions and incidences are derived from product labeling unless otherwise specified.

Frequency not defined:

Cardiovascular: Hypotension, localized phlebitis, peripheral edema, venous thrombosis

Central nervous system: Chills

Dermatologic: Pruritus, skin rash, urticaria

Endocrine & metabolic: Acid-base imbalance, electrolyte disturbance (dilution of electrolytes), hyperchloremia, hyperchloremic metabolic acidosis, hypernatremia, hypervolemia, hyponatremia

Local: Injection site infection, infusion site reaction

Neuromuscular & skeletal: Tremor

Respiratory: Pulmonary edema

Miscellaneous: Fever

<1%, postmarketing, and/or case reports: Hypersensitivity reaction, infusion related reaction

Contraindications

Hypersensitivity to sodium chloride or any component of the formulation; hypertonic uterus, hypernatremia, fluid retention

Warnings/Precautions

Concerns related to adverse effects:

• Extravasation: Concentrated solutions of IV sodium chloride (>1%) are irritants (with vesicant-like properties at higher osmolarities); depends on osmolarity; higher osmolarity is associated with a higher risk. Ensure proper needle or catheter placement prior to and during infusion. Avoid extravasation.

• Hemolysis: The use of hypotonic saline solutions (eg, sodium chloride 0.225%) may result in hemolysis if administered rapidly and for prolonged periods. If hypotonic saline solutions become necessary, administration as D5W/NaCl 0.2% or NaCl 0.45% is recommended for most patients (eg, those without hyperglycemia).

• Hyponatremia: Administration of low sodium or sodium-free IV solutions may result in significant hyponatremia or water intoxication; monitor serum sodium concentration closely. In the treatment of acute hypernatremia (ie, development over a couple of hours), serum sodium concentration should be corrected no faster than 1 to 2 mEq/L per hour. If patient has been chronically hypernatremic, correct serum sodium no faster than 0.5 mEq/L per hour and by no more than 8 mEq/L in a given 24-hour period; use extreme caution since rapid correction may result in cerebral edema, herniation, coma, and death (Adrogué 2000; Kraft 2005; Sterns 2021).

• Sodium toxicity: Rate of correction is dependent upon whether or not hyponatremia is acute or chronic. Sodium toxicity (eg, osmotic demyelination syndrome [ODS]) is almost exclusively related to how fast a sodium deficit is corrected; both rate and magnitude are extremely important. For patients with acute (<24 hours) or chronic (>48 hours), severe (<120 mEq/L) hyponatremia, a serum sodium concentration increase of 4 to 6 mEq/L within a 24-hour period is sufficient for most patients. In chronic severe hyponatremia, overcorrection risks iatrogenic ODS. For patients with severe symptoms or other need for urgent correction, may increase by 4 to 6 mEq/L within the first 6 hours and postpone any further correction until the next day at a correction rate of 4 to 6 mEq/L per day. Do not increase serum sodium by >8 mEq/L in any 24-hour period. Choice of infusate sodium concentration is dependent upon the severity of the hyponatremia with more concentrated solutions (eg, NaCl 3%) for more severe cases; monitor serum sodium closely during administration (Sterns 2013; Sterns 2021).

Disease-related concerns:

• Cirrhosis: Use with caution in patients with cirrhosis.

• Edema: Use with caution in patients with edema.

• Heart failure: Use with caution in patients with heart failure.

• Hypertension: Use with caution in patients with hypertension.

• Renal impairment: Use with caution in patients with renal impairment; may cause sodium retention.

Dosage form specific issues:

• Benzyl alcohol and derivatives: Bacteriostatic sodium chloride contains benzyl alcohol; large amounts of benzyl alcohol (≥99 mg/kg/day) have been associated with a potentially fatal toxicity (“gasping syndrome”) in neonates; the “gasping syndrome” consists of metabolic acidosis, respiratory distress, gasping respirations, CNS dysfunction (including convulsions, intracranial hemorrhage), hypotension, and cardiovascular collapse (AAP ["Inactive" 1997]; CDC 1982); some data suggests that benzoate displaces bilirubin from protein binding sites (Ahlfors 2001); avoid or use dosage forms containing benzyl alcohol with caution in neonates. See manufacturer's labeling.

• Irrigants: For external use only; not for parenteral use. Do not use during electrosurgical procedures. Irrigating fluids may be absorbed into systemic circulation; monitor for fluid or solute overload.

• Wound Wash Saline: For single-patient use only.

Warnings: Additional Pediatric Considerations

In neonates, maximum serum concentration correction rate should generally not exceed 10 mEq/L/day; in infants, children, adolescents, and adults, do not exceed a maximum serum concentration correction rate of 12 mEq/L/day. Administration of low sodium or sodium free IV solutions may result in significant hyponatremia or water intoxication in pediatric patients; monitor serum sodium concentration.

Some dosage forms may contain propylene glycol; in neonates, large amounts of propylene glycol delivered orally, intravenously (eg, >3,000 mg/day), or topically have been associated with potentially fatal toxicities which can include metabolic acidosis, seizures, renal failure, and CNS depression; toxicities have also been reported in children and adults including hyperosmolality, lactic acidosis, seizures, and respiratory depression; use caution (AAP 1997; Shehab 2009).

Metabolism/Transport Effects

None known.

Drug Interactions

Lithium: Sodium Chloride may increase the excretion of Lithium. Risk C: Monitor therapy

Tolvaptan: Sodium Chloride may enhance the adverse/toxic effect of Tolvaptan. Specifically, Hypertonic Saline may increase the risk for too rapid of an increase in serum sodium concentrations. Management: This interaction is specific to hypertonic saline. Avoid concurrent use of hypertonic saline with tolvaptan. Risk X: Avoid combination

Pregnancy Risk Factor

C (show table)

Pregnancy Considerations

Animal reproduction studies have not been conducted. Sodium requirements do not change during pregnancy (IOM 2004). Nasal saline rinses may be used for the treatment of pregnancy rhinitis (Wallace 2008)

Breast-Feeding Considerations

Sodium is found in breast milk. Sodium requirements do not change during lactation (IOM 2004).

Monitoring Parameters

Serum sodium, potassium, chloride, bicarbonate concentrations, and osmolarity; intake and output, weight. Monitor infusion site (during IV administration of hypertonic solutions).

Reference Range

Serum/plasma sodium concentration:

Neonates:

Full-term: 133 to 142 mEq/L

Premature: 132 to 140 mEq/L

Children ≥2 months to Adults: 135 to 145 mEq/L

Mechanism of Action

Principal extracellular cation; functions in fluid and electrolyte balance, osmotic pressure control, and water distribution

Pharmacodynamics and Pharmacokinetics

Absorption: Oral: Rapid

Distribution: Widely distributed

Excretion: Primarily urine; also sweat, tears, saliva

Pricing: US

Nebulization (HyperSal Inhalation)

3.5% (per mL): $0.22

7% (per mL): $0.22

Nebulization (Sodium Chloride Inhalation)

0.9% (per mL): $0.04 - $0.14

3% (per mL): $0.10

7% (per mL): $0.08 - $0.10

10% (per mL): $0.10

Ointment (Altachlore Ophthalmic)

5% (per gram): $3.89

Ointment (Muro 128 Ophthalmic)

5% (per gram): $4.22

Ointment (Sodium Chloride (Hypertonic) Ophthalmic)

5% (per gram): $3.09 - $5.01

Pack (Ayr Saline Nasal Neti Rinse Nasal)

1.57 g (per each): $0.19

Pack (AYR Saline Nasal Rinse Nasal)

1.57 g (per each): $0.08

Solution (Afrin Saline Nasal Mist Nasal)

0.65% (per mL): $0.09

Solution (Altachlore Ophthalmic)

5% (per mL): $1.16

Solution (Ayr Nasal)

0.65% (per mL): $0.05

Solution (Ayr Nasal Mist Allergy/Sinus Nasal)

2.65% (per mL): $0.07

Solution (Ayr Saline Nasal Drops Nasal)

0.65% (per mL): $0.05

Solution (Baby Ayr Saline Nasal)

0.65% (per mL): $0.08

Solution (Entsol Nasal Nasal)

3% (per mL): $0.33

Solution (Muro 128 Ophthalmic)

2% (per mL): $1.21

5% (per mL): $1.28

Solution (Nasal Moist Nasal)

0.65% (per mL): $0.16

Solution (Ocean for Kids Nasal)

0.65% (per mL): $0.08

Solution (Ocean Nasal Spray Nasal)

0.65% (per mL): $0.07

Solution (Safe Wash External)

0.9% (per mL): $0.03

Solution (Saline Nasal Spray Nasal)

0.65% (per mL): $0.03 - $0.04

Solution (Saljet External)

0.9% (per mL): $0.02

Solution (Saljet Rinse External)

0.9% (per mL): $0.02

Solution (Sodium Chloride (Hypertonic) Ophthalmic)

5% (per mL): $0.33 - $0.98

Solution (Sodium Chloride (PF) Injection)

0.9% (per mL): $0.10 - $4.70

Solution (Sodium Chloride Flush Intravenous)

0.9% (per mL): $0.06 - $0.15

Solution (Sodium Chloride Injection)

2.5 mEq/mL (per mL): $0.04 - $0.20

Solution (Sodium Chloride Intravenous)

0.45% (per mL): $0.01 - $0.02

0.9% (per mL): $0.02 - $0.32

3% (per mL): $0.01 - $0.02

4 mEq/mL (per mL): $0.05 - $0.14

5% (per mL): $0.01 - $0.02

Solution (Sodium Chloride Irrigation)

0.9% (per mL): $0.00 - $0.12

Solution (Sodium Chloride Oral)

4 mEq/mL (per mL): $0.12

Solution (Wound Wash Saline External)

0.9% (per mL): $0.02

Tablets (Sodium Chloride Oral)

1 g (per each): $0.08 - $0.29

Disclaimer: A representative AWP (Average Wholesale Price) price or price range is provided as reference price only. A range is provided when more than one manufacturer's AWP price is available and uses the low and high price reported by the manufacturers to determine the range. The pricing data should be used for benchmarking purposes only, and as such should not be used alone to set or adjudicate any prices for reimbursement or purchasing functions or considered to be an exact price for a single product and/or manufacturer. Medi-Span expressly disclaims all warranties of any kind or nature, whether express or implied, and assumes no liability with respect to accuracy of price or price range data published in its solutions. In no event shall Medi-Span be liable for special, indirect, incidental, or consequential damages arising from use of price or price range data. Pricing data is updated monthly.

Brand Names: International
  • Ai Na Duo (CN);
  • Alive (BR);
  • Alrin Baby (IL);
  • Antiedema (ES);
  • Apisal (AE, QA, SA);
  • Aqua-Rinosol (RU);
  • Breathy (ID);
  • Chlorek Sodowy 24Na (PL);
  • Clean-AF (IL);
  • Descodrin (BR);
  • Droser (TR);
  • Earinse (HK);
  • Fima NS (ID);
  • Fisiolimp (CL);
  • Fizyolen (TR);
  • Hidrathea (ES);
  • Hiperton (MX);
  • HO-SOL (UA);
  • Hydrabak (IT);
  • Hynasal (IN);
  • Hypersalt (PH);
  • Hypersol (AR, BD, IN);
  • Hytosol (IN);
  • Infusol (MY);
  • Inj. natrii chlorati isotonica (PL);
  • Jellywash (FR);
  • Kochsalz (AT);
  • Larmabak (AR, FR, HK, SG, TR, VE);
  • Libenar (IT);
  • Maresis (BR);
  • Maxidrate (BR);
  • Miwana (PL);
  • Muco Clear (GB);
  • Muconase (PH);
  • Muro 128 (KR);
  • Naclin (AR);
  • Nafavine (VE);
  • Narium (AU, NZ);
  • Nasakid (CL);
  • Nasalt (IN);
  • Nasoclear (IN, PH);
  • Natriclo (BE);
  • Natrii chloridum (EE);
  • Natrii chloridum 0,9% solutio pro irrigatione (PL);
  • Natrium chloratum (PL);
  • Nazol Aqua (RU);
  • Nebusal (GB);
  • Neorino (BR);
  • No-Sol (UA);
  • Normaline (AE);
  • Normasol (SG);
  • Normlgel (FR);
  • Norsalin (QA);
  • Nosalen (UA);
  • Ocean Spray (IL);
  • Oftalook (AR);
  • Oftarinol (PL);
  • Olynth salin (DE);
  • Omni-Sorb (DE);
  • Ophth-hypertonic (PK);
  • Ophth-lubric (PK);
  • Osmogel (IN);
  • Otrisalin (TR);
  • Phylarm (MX);
  • Physiodose (HK, IT, MY, PL);
  • Physiologic (CH);
  • Physiologicasol (BE);
  • Physiorhine (BE);
  • Polyrinse (ZA);
  • Rinokid (CL);
  • Rinolyuks (UA);
  • Rinomist (QA);
  • Rinowash (IT);
  • Rizosin (RU);
  • Salacyn (SG);
  • Salimist (SA);
  • Salinor (BD);
  • Saloride (BD);
  • Salsol (HU);
  • Sensitive Eyes Saline Solution (PL);
  • Serophy (CH);
  • Sinus (CL);
  • Snif (BR, PH);
  • Sodisol (BD);
  • Sodium Chloride (PL);
  • Solnasin (PL);
  • Tipotaf (IL);
  • Totalatlas (AR);
  • Urgo sterile (DE);
  • Wida NS (ID);
  • Xenosol (BD);
  • Xylisol (AR)


For country abbreviations used in Lexicomp (show table)

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