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
How Supplied
NaCl 3% 250 ml
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