Sodium chloride is used as a source of sodium and chloride ions, which are essential ions.
Sodium chloride injections are used as a source of sodium chloride and water for hydration. Sodium chloride is used in the prevention or treatment of deficiencies of sodium and chloride ions and in the prevention of muscle cramps and heat prostration resulting from excessive perspiration during exposure to high temperature. Sodium chloride is also used to treat deficiencies of sodium and chloride caused by excessive diuresis or excessive salt restriction.
0.45% Sodium chloride injection is used principally as a hydrating solution and may be used to assess renal function status, since more water is provided than is required for excretion of salt. 0.45% Sodium chloride injection is also used in the management of hyperosmolar diabetes.
0.9% Sodium chloride injection is used for extracellular fluid replacement and in the management of metabolic alkalosis in the presence of fluid loss and mild sodium depletion. 0.9% Sodium chloride injection (normal saline) is also used as a priming fluid for hemodialysis procedures and to initiate and terminate blood transfusions.
Hypertonic (i.e., 3%, 5%) sodium chloride injection is used in the management of severe sodium chloride depletion when rapid electrolyte restoration is essential. Severe sodium chloride depletion may occur in the presence of heart failure or renal impairment, or during surgery or postoperatively. In these conditions, chloride loss often exceeds sodium loss. Hypertonic sodium chloride injections are also used in the management of hyponatremia and hypochloremia resulting from administration of sodium-free fluids during fluid and electrolyte therapy; in the management of extreme dilution of extracellular fluid following excessive water intake (e.g., that resulting from multiple enemas or perfusion of irrigating solutions into open venous sinuses during transurethral prostatic resections); and in the emergency treatment of severe sodium chloride depletion resulting from excess sweating, vomiting, diarrhea, and other conditions.
Sodium chloride injections are also used as pharmaceutical aids and diluents for the infusion of compatible drug additives.
Bacteriostatic sodium chloride injection is used as a diluent; however, the compatibility of the antimicrobial agent(s) contained in bacteriostatic sodium chloride injection and the particular drug that is to be dissolved or diluted must be considered.
Sodium chloride inhalation solution is used for inhalation via nebulization, for dilution of compatible drugs for nebulization, and for tracheal lavage and irrigation.
Sodium chloride may be administered orally or by IV infusion. When 3 or 5% sodium chloride injection is indicated, the solution should be administered IV via a large vein, with care taken to avoid infiltration. Sodium chloride injection containing 2.5 or 4 mEq/mL each of sodium and chloride must be diluted with a compatible IV solution prior to IV administration.
Sodium chloride also is administered via oral inhalation. Sterile inhalation solutions of sodium chloride are commercially available in single-dose containers for inhalation via nebulization, for dilution of compatible drugs for nebulization, and for tracheal lavage and irrigation and in metered-dose aerosols for dilution of compatible drugs for nebulization.
Extemporaneously Compounded Oral Liquid
Extemporaneously compounded oral liquid formulations of sodium chloride have been prepared.252
Standardized concentrations for an extemporaneously prepared oral liquid preparation of sodium chloride have been established through Standardize 4 Safety (S4S), a national patient safety initiative to reduce medication errors, especially during transitions of care. Multidisciplinary expert panels were convened to determine recommended standard concentrations. Because recommendations from the S4S panels may differ from the manufacturer's prescribing information, caution is advised when using concentrations that differ from labeling, particularly when using rate information from the label. 252
For additional information on S4S (including updates that may be available), see [Web].
Concentration Standards |
|---|
4 mEq/mL |
Standardized concentrations for IV sodium chloride have been established through Standardize 4 Safety (S4S), a national patient safety initiative to reduce medication errors, especially during transitions of care. Multidisciplinary expert panels were convened to determine recommended standard concentrations. Because recommendations from the S4S panels may differ from the manufacturer's prescribing information, caution is advised when using concentrations that differ from labeling, particularly when using rate information from the label. 249 For additional information on S4S (including updates that may be available), see [Web].
Patient Population | Concentration Standards | Dosing Units |
|---|---|---|
Pediatric patients (<50 kg) | 0.5 mEq/mL (3%) | mL/kg/hour or mEq/kg/hour, depending on institution protocols |
Dosage of sodium chloride depends on the age, weight, clinical condition, and fluid, electrolyte, and acid-base balance of the patient. The usual adult sodium and chloride requirements can be adequately fulfilled by IV infusion of 1 L of 0.9% sodium chloride injection daily or 1-2 L of 0.45% sodium chloride injection daily. The usual initial IV dose of 3 or 5% sodium chloride injection is 100 mL given over a 1-hour period; before additional amounts are administered, serum electrolyte concentrations, including chloride and bicarbonate, should be determined to assess the need for additional sodium chloride. IV infusion of 3 or 5% sodium chloride injection should not exceed 100 mL/hour. The usual oral replacement dosage of sodium chloride is 1-2 g 3 times daily.
For further information on chemistry and stability, pharmacology, uses, cautions, and dosage and administration of sodium chloride, specialized references and the manufacturers'; labeling should be consulted.
Reactions that may occur because of the solution (e.g., from contamination) or administration technique include fever, infection at the site of injection, venous thrombosis or phlebitis extending from the site of injection, and extravasation. Hypervolemia or symptoms resulting from an excess or deficit of one or more ions present in the solution may also occur. Excessive administration of sodium chloride may result in hypernatremia and large amounts of chloride may cause a loss of bicarbonate with an acidifying effect. If an adverse effect occurs during administration of sodium chloride injection, the infusion should be discontinued, the patient evaluated, appropriate therapeutic measures instituted if necessary, and the remainder of the fluid saved for examination if necessary.
Precautions and Contraindications
Changes in fluid balance, electrolyte concentrations, and acid-base balance should be evaluated clinically and via periodic laboratory determinations during prolonged therapy with sodium chloride and in patients whose condition warrants such evaluation. Substantial changes may require additional electrolyte supplements or other appropriate therapy. Additional electrolyte supplementation may also be required in patients with substantial electrolyte losses resulting from conditions such as protracted nasogastric suctioning, vomiting, diarrhea, or GI fistula drainage.
Sodium chloride should be used with extreme caution, if at all, in patients with congestive heart failure or other edematous or sodium-retaining conditions, in patients with severe renal insufficiency, in patients with liver cirrhosis, and in patients receiving corticosteroids or corticotropin; particular caution is necessary in geriatric or postoperative patients. IV administration of sodium chloride may cause fluid and/or solute overload resulting in dilution of serum electrolytes, overhydration, congestive conditions, or pulmonary edema. The risk of dilutional conditions is inversely proportional to the electrolyte concentration administered, and the risk of solute overload and resultant congestive conditions with peripheral and/or pulmonary edema is directly proportional to the electrolyte concentration administered. The manufacturers warn that excessive IV administration of sodium chloride may result in hypokalemia.
Sodium chloride is contraindicated in patients with conditions in which administration of sodium and chloride is detrimental. Sodium chloride 3 and 5% injections are also contraindicated in the presence of increased, normal, or only slightly decreased serum electrolyte concentrations.
Bacteriostatic sodium chloride injection containing benzyl alcohol as a preservative (antimicrobial agent) should not be used for diluting or reconstituting drugs for administration in neonates nor should it be used to flush intravascular catheters in neonates. Several deaths have been reported in neonates weighing less than 2.5 kg in whom bacteriostatic sodium chloride for injection containing 0.9% benzyl alcohol was used for flushing IV catheters; some of these neonates received additional benzyl alcohol when bacteriostatic sodium chloride injection was used to dilute or reconstitute drugs. The deaths were usually preceded by a syndrome that included metabolic acidosis, CNS depression, respiratory distress progressing to gasping respiration, hypotension, renal failure, and, occasionally, seizures and intracranial hemorrhage. High concentrations of benzyl alcohol, benzoic acid, and hippuric acid (a metabolite) were present in blood and urine in these neonates. Benzyl alcohol toxicity apparently was caused by administration of relatively large daily doses (99-404 mg/kg daily) of the preservative in proportion to the neonate's weight. Although these neonates had biochemical evidence of benzyl alcohol toxicity, they also had serious underlying conditions.
Solutions of sodium chloride closely approximate the composition of the extracellular fluid of the body. A 0.9% solution of sodium chloride (i.e., isotonic) has approximately the same osmotic pressure as body fluids.
Sodium chloride provides electrolyte supplementation. Sodium is the major cation of extracellular fluid and functions principally in the control of water distribution, fluid and electrolyte balance, and osmotic pressure of body fluids. Sodium is also associated with chloride and bicarbonate in the regulation of acid-base balance. Chloride, the major extracellular anion, closely follows the physiologic disposition of sodium, and changes in the acid-base balance of the body are reflected by changes in serum chloride concentration.
Sodium chloride injection is capable of inducing diuresis depending on the volume administered and the clinical condition of the patient. 0.9% Sodium chloride will not hemolyze erythrocytes.
Sodium chloride occurs as colorless, cubic crystals or as a white, crystalline powder. Sodium chloride has a saline taste and is freely soluble in water, slightly more soluble in boiling water, and slightly soluble in alcohol.
Sodium chloride injection is a sterile solution of sodium chloride in water for injection. Sodium chloride injections have a pH of 4.5-7 and contain no bacteriostatic or antimicrobial agents or added buffers. Bacteriostatic sodium chloride injection is a sterile, isotonic solution of sodium chloride in water for injection and contains one or more antimicrobial agents.
0.45% Sodium chloride injection is a hypotonic solution that contains 77 mEq/L each of sodium and chloride and has a calculated osmolarity of 154 mOsm/L. 0.9% Sodium chloride injection (normal saline) is an isotonic solution that contains 154 mEq/L each of sodium and chloride and has a calculated osmolarity of 308 mOsm/L. 3% Sodium chloride injection is a hypertonic solution that contains 513 mEq/L each of sodium and chloride and has a calculated osmolarity of about 1025 mOsm/L. 5% Sodium chloride injection is a hypertonic solution that contains 855 mEq/L each of sodium and chloride and has a calculated osmolarity of about 1710 mOsm/L. Sodium chloride injection containing 2.5 mEq/mL each of sodium and chloride has a calculated osmolarity of about 5000 mOsm/L. Sodium chloride injection containing 4 mEq/mL each of sodium and chloride has a calculated osmolarity of about 8000 mOsm/L.
Sodium chloride inhalation solution is a sterile solution of sodium chloride in water purified by distillation or reverse osmosis and then rendered sterile. The inhalation solution has a pH of 4.5-7 and contains no preservatives or other additives. Sodium chloride inhalation solution is commercially available in single-dose containers for inhalation via nebulization, for dilution of compatible drugs for nebulization, and for tracheal lavage and irrigation and in metered-dose aerosols for dilution of compatible drugs for nebulization.
Bacteriostatic sodium chloride injections should be protected from freezing.
Additional Information
The American Society of Health-System Pharmacists, Inc. represents that the information provided in the accompanying monograph was formulated with a reasonable standard of care, and in conformity with professional standards in the field. Readers are advised that decisions regarding use of drugs are complex medical decisions requiring the independent, informed decision of an appropriate health care professional, and that the information contained in the monograph is provided for informational purposes only. The manufacturer's labeling should be consulted for more detailed information. The American Society of Health-System Pharmacists, Inc. does not endorse or recommend the use of any drug. The information contained in the monograph is not a substitute for medical care.
Excipients in commercially available drug preparations may have clinically important effects in some individuals; consult specific product labeling for details.
Please refer to the ASHP Drug Shortages Resource Center for information on shortages of one or more of these preparations.
Routes | Dosage Forms | Strengths | Brand Names | Manufacturer |
|---|---|---|---|---|
Oral Inhalation | Solution, for nebulization | 0.9%* | Dey-Pak® Sodium Chloride Solution | Dey |
Dey-Vial® Sodium Chloride Solution | Dey | |||
Nephron | ||||
3% | Dey-Pak® Sodium Chloride Solution | Dey | ||
10% | Dey-Pak® Sodium Chloride Solution | Dey | ||
Parenteral | Injection | 0.45%* | Baxter | |
0.9%* | Baxter | |||
0.9% Sodium Chloride Injection in Thermoject® System (with Thermoject® injector and empty vial for temperature probe) | Hospira | |||
3%* | Baxter | |||
5%* | Baxter | |||
Injection, for preparation of IV admixtures | 2.5 mEq of Na+/mL and Cl-/mL pharmacy bulk package | |||
4 mEq of Na+/mL and Cl-/mL pharmacy bulk package | Abraxis |
* available from one or more manufacturer, distributor, and/or repackager by generic (nonproprietary) name
Routes | Dosage Forms | Strengths | Brand Names | Manufacturer |
|---|---|---|---|---|
Parenteral | Injection | 0.9% (with benzyl alcohol or parabens)* | Bacteriostatic Sodium Chloride Injection (with 0.9% benzyl alcohol or parabens) | American Regent |
* available from one or more manufacturer, distributor, and/or repackager by generic (nonproprietary) name
AHFS® Drug Information. © Copyright, 1959-2025, Selected Revisions June 10, 2024. American Society of Health-System Pharmacists, Inc., 4500 East-West Highway, Suite 900, Bethesda, MD 20814.
Only references cited for selected revisions after 1984 are available electronically.
249. ASHP. Standardize 4 Safety: pediatric continuous infusion standard. Updated 2024 Mar. From ASHP website. Updates may be available at ASHP website. [Web]
252. ASHP. Standardize 4 Safety: compounded oral liquid standards. Updated 2024 Mar. From ASHP website. Updates may be available at ASHP website