3% Hypertonic saline
Classification
Sodium salt, electrolyte supplement
Indications
CCP: Hyponatremia
CCP: Intracranial hypertension
Contraindications
- Hypersensitivity
- Hypernatremia
- Fluid retention
- Hypertonic uterus
Cautions
- Large amounts of benzyl alcohol (≥99 mg/kg/day) have been associated with a potentially fatal toxicity (“gasping syndrome”) in neonates.
- 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.
Adult dosages
CCP: Hyponatremia (Acute)
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)
- Asymptomatic
- NaCl 3% 50 ml IV bolus over 5 minutes
- Symptomatic
- NaCl 3% 100 ml IV over 10 minutes
- May repeat up to 3 doses over 30 minutes
CCP: Intracranial hypertension
- NaCl 3% 5ml/kg IV bolus
Pediatric Considerations And Dosing
CCP: Hyponatremia
- Symptomatic
- NaCl 3% IV 2-5 ml/kg over 20 minutes to a max dose of 150 ml/dose.
CCP: Intracranial hypertension
- NaCl 3% 2-5ml/kg IV over 10 minutes
Mechanism Of Action
Sodium is the principle extracellular cation. It functions in fluid and electrolyte balance. In turn osmotic pressure control and water distribution are regulated.
Pharmacokinetics
Onset: immediate
Adverse Effects
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
Warning And Precautions
- Concentrated solutions of IV sodium chloride (>1%) are irritants (with vesicant-like properties at higher osmolarities)
- The use of hypotonic saline solutions (eg, sodium chloride 0.225%) may result in hemolysis if administered rapidly and for prolonged periods.
- 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.
- Large amounts of benzyl alcohol (≥99 mg/kg/day) have been associated with a potentially fatal toxicity (“gasping syndrome”) in neonates.
- 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.
- 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.
Drug Interactions
- Lithium
- Tolvptan