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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

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3% Hypertonic saline

Classification

Indications

Contraindications

Adult dosages

Pediatric Considerations And Dosing

Mechanism Of Action

Pharmacokinetics

Adverse Effects

Warning And Precautions

Drug Interactions