1. Clinical Overview
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.
| Onset | Duration | Bioavailability |
|---|---|---|
| Immediate upon intravenous administration. | Duration is variable, dependent on the patient's fluid and electrolyte balance, renal function, and the rate of administration. Electrolyte effects can persist for several hours. | 100% (Intravenous administration). |
2. Mechanism of Action
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.
3. Indications & Uses
- Severe symptomatic hyponatremia (with neurological symptoms like seizures, coma)
- Volume resuscitation in specific cases of hyponatremic hypovolemia
- Preparation of medications for injection requiring a hypertonic vehicle
4. Dosage & Administration
Adult Dosage: 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).
Administration: 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.
5. Side Effects
Common side effects may include:
- Venous irritation or pain at the injection site
- Phlebitis or thrombophlebitis
- Sensation of warmth
6. Drug Interactions
| Drug | Effect | Severity |
|---|---|---|
| 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 |
7. Patient Counselling
- Do report any pain, redness, or swelling at the IV site immediately.
- Do inform all healthcare providers about all medications you are taking.
- Do not adjust the infusion rate yourself.
- Do adhere to any prescribed dietary sodium restrictions as advised by your doctor.
8. Toxicology & Storage
Overdose: Symptoms of overdose include hypernatremia (thirst, fever, dry mucous membranes, restlessness, irritability, seizures, coma), pulmonary edema (dyspnea, rales), hypertension, tachycardia, metabolic acidosis, and severe tissue damage if extravasated.
Storage: Store at room temperature (not exceeding 30°C). Protect from freezing and direct sunlight. Do not use if the container is damaged, the seal is broken, or the solution is cloudy, discolored, or contains visible particles. Keep out of reach of children. Single-use container. Discard any unused portion.