Sodium Chloride (4gm/200ml) is a sterile, non-pyrogenic, hypertonic solution for intravenous infusion. It provides 2000 mg (34.2 mEq) of Sodium and 2000 mg (34.2 mEq) of Chloride per 200 ml, with an osmolarity of approximately 1710 mOsm/L. It is a critical electrolyte replenisher and volume expander used to correct severe sodium and chloride deficiencies and to induce osmotic diuresis.
Adult: Dosage is HIGHLY INDIVIDUALIZED based on serum sodium deficit, severity of symptoms, and patient's volume status. A common approach for severe hyponatremia: Initial infusion rate often does not exceed 1-2 ml/kg/hour (e.g., 70-140 ml/hour for a 70kg patient). The rate and total volume are titrated to achieve a desired rate of serum sodium increase (typically not more than 10-12 mEq/L in first 24 hours and 18 mEq/L in first 48 hours to avoid osmotic demyelination).
Note: FOR INTRAVENOUS USE ONLY. Must be administered via a central venous catheter or a large peripheral vein to minimize venous irritation. Use an infusion pump to control rate precisely. The solution is sterile and non-pyrogenic. Do not use if the container is leaking, cloudy, or contains particulate matter. Do not administer simultaneously with blood through the same infusion set due to risk of hemolysis.
Sodium is the major cation of extracellular fluid and plays a critical role in maintaining osmotic pressure, acid-base balance, and the electrochemical gradient across cell membranes, which is essential for nerve impulse transmission and muscle contraction. Chloride is the major extracellular anion. The 4gm/200ml (5.85%) hypertonic solution creates a significant osmotic gradient, drawing water from the intracellular and interstitial compartments into the intravascular space, thereby expanding plasma volume and correcting severe hyponatremia.
Pregnancy: Category C (US FDA). Sodium chloride crosses the placenta. Use during pregnancy only if clearly needed and potential benefit justifies potential risk to the fetus. Maternal hyponatremia can be harmful to the fetus. Monitor electrolytes closely.
Driving: The underlying condition (e.g., hyponatremia) or its over-correction can cause neurological symptoms (dizziness, confusion, seizures) that impair driving ability. Patients should be advised not to drive until fully stabilized.
| Corticosteroids (e.g., Hydrocortisone, Prednisolone) | Increased sodium retention, potentiating risk of edema and hypertension. | Major |
| Lithium | Increased sodium levels may reduce lithium clearance, increasing risk of lithium toxicity. | Major |
| Loop Diuretics (e.g., Furosemide) | May enhance sodium excretion, potentially counteracting the effect of hypertonic saline. Requires careful monitoring of electrolytes. | Moderate |
| NSAIDs (e.g., Ibuprofen, Diclofenac) | May cause sodium and water retention, increasing risk of fluid overload. | Moderate |
| ACE Inhibitors (e.g., Enalapril, Ramipril) | Concurrent use in heart failure patients requires extreme caution due to risk of hyperkalemia and altered renal function. | Moderate |
Same composition (Sodium Chloride (4gm/200ml)), different brands: