General

High Alert Medication: This medication bears a heightened risk of causing significant patient harm when it is used in error.

Pronunciation:
soe-dee-um klor-ide

Trade Name(s)

• Slo-Salt

Ther. Class.

mineral and electrolyte replacements/supplements

Indications

• IV Hydration and provision of NaCl in deficiency states.
• Maintenance of fluid and electrolyte status in situations in which losses may be excessive (excess diuresis or severe salt restriction).
• 0.45% ("half-normal saline") solution is most commonly used for hydration and the treatment of hyperosmolar diabetes (hypotonic).

• 0.9% ("normal saline") solution is used for:

  • Replacement,
  • Treatment of metabolic alkalosis,
  • A priming fluid for hemodialysis,
  • To begin and end blood transfusions.
• Small volumes of 0.9% NaCl (preservative-free or bacteriostatic) are used to reconstitute or dilute other medications.

• Hypertonic solution (3%, 5%) may be required in situations in which rapid replacement of sodium is necessary:

  • Hyponatremia,
  • Hypochloremia,
  • Renal failure,
  • Heart failure.
• PO Prevention of or management of volume depletion due to salt restriction or heat prostration when excessive sweating occurs during exposures to high temperatures.
• Irrigating Solutions: 0.9% and 0.45% may be used as irrigating solutions.
• Concentrated sodium chloride: Used as an additive to parenteral fluid therapy in very specific situations.

Action

• Sodium is a major cation in extracellular fluid and helps maintain water distribution, fluid and electrolyte balance, acid-base equilibrium, and osmotic pressure.
• Chloride is the major anion in extracellular fluid and is involved in maintaining acid-base balance. Solutions of NaCl resemble extracellular fluid.
• Reduces corneal edema by an osmotic effect.

Therapeutic Effect(s):

IV PO Replacement in deficiency states and maintenance of homeostasis.

Pharmacokinetics

Absorption: Well absorbed following oral administration. Replacement solutions of NaCl are administered IV only.

Distribution: Rapidly and widely distributed.

Metabolism and Excretion: Excreted primarily by the kidneys.

Half-life: Unknown.

TIME/ACTION PROFILE (various clinical effects†)

Contraindication/Precautions

Contraindicated in:

• Hypertonic (3%, 5%) solutions should not be used in patients with elevated, slightly decreased, or normal serum sodium;
• Fluid retention or hypernatremia.

Use Cautiously in:

• Patients prone to metabolic, acid-base, or fluid and electrolyte abnormalities, including:

  • geriatric patients,
  • those with nasogastric suctioning,
  • vomiting,
  • diarrhea,
  • diuretic therapy,
  • glucocorticoid therapy,
  • fistulas,
  • HF,
  • severe renal failure,
  • severe liver diseases (additional electrolytes may be required);
• Pedi:  NaCl preserved with benzyl alcohol should not be used in neonates;
• Inadequate hydration (water and other electrolytes must be replaced).

Adverse Reactions/Side Effects

Seen primarily during PO and IV use

CV: HF, PULMONARY EDEMA, edema

F and E: hypernatremia, hypervolemia, hypokalemia

Local:  IV: extravasation, irritation at IV site

* CAPITALS indicate life-threatening.
Underline indicate most frequent.

Interactions

Drug-Drug

• Excessive amounts of NaCl may partially antagonize the effects of  antihypertensives.
• Use with  corticosteroids  may result in excess sodium retention.

Route/Dosage

IV (Adults): 0.9% NaCl (isotonic): 1 L (contains 150 mEq sodium/L), rate and amount determined by condition being treated.   0.45% NaCl (hypotonic): 1–2 L (contains 75 mEq sodium/L), rate and amount determined by condition being treated.  3%, 5% NaCl (hypertonic): 100 mL over 1 hr (3% contains 50 mEq sodium per 100 mL; 5% contains 83.3 mEq sodium per 100 mL).

PO (Adults): 1–2 g 3 times daily.

PO IV (Children and Infants): Maintenance sodium requirements: 3–4 mEq/kg/day (maximum: 150 mEq/day).

PO IV (Neonates): Maintenance sodium requirements: 1–4 mEq/kg/day.

Availability (generic available)

IV solutions: 0.45%, 0.9%, 3%, 5%

Diluents: 0.9%

Concentrate for dilution: 14.6%, 23.4%

Tablets: 650 mg^OTC

In Combination with: potassium (Slo-Salt-K), dextrose, electrolytes.

Assessment

• Assess fluid balance (intake and output, daily weight, edema, lung sounds) throughout therapy.
• Assess patient for symptoms of hyponatremia (headache, tachycardia, lassitude, dry mucous membranes, nausea, vomiting, muscle cramps) or hypernatremia (edema, weight gain, hypertension, tachycardia, fever, flushed skin, mental irritability) throughout therapy. Sodium is measured in relation to its concentration to fluid in the body, and symptoms may change based on patient's hydration status.

Lab Test Considerations:

Monitor serum sodium, potassium, bicarbonate, and chloride concentrations and acid-base balance periodically for patients receiving prolonged therapy with sodium chloride.

• Monitor serum osmolarity in patients receiving hypertonic saline solutions.

Potential Diagnoses

• Deficient fluid volume (Indications) 
• Excess fluid volume (Side Effects) 

Implementation

• High Alert: Accidental administration of hypertonic sodium chloride solutions (greater than 0.9%) have resulted in serious electrolyte imbalances. Do not confuse vials of concentrated sodium chloride (23.4%) with vials of sodium chloride flush solution (0.9%).

• Dose of NaCl depends on patient's age, weight, condition, fluid and electrolyte balance, and acid-base balance.

  • Do not administer bacteriostatic NaCl containing benzyl alcohol as a preservative to neonates. This should not be used to reconstitute or to dilute solutions or to flush intravascular catheters in neonates.
  • Infusion of 0.45% NaCl is hypotonic, 0.9% NaCl is isotonic, and 3% and 5% NaCl are hypertonic.

Patient/Family Teaching

• Explain to patient the purpose of the infusion.
• Advise patients at risk for dehydration due to exposure to extreme temperatures when and how to take NaCL tablets. Inform patients that undigested tablets may be passed in the stool; oral electrolyte solutions are preferable.

Evaluation/Desired Outcomes

• Prevention or correction of dehydration.
• Normalization of serum sodium and chloride levels.
• Prevention of heat prostration during exposure to high temperatures.