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Sod Chloride 0.45%/20meq Kcl

Manufacturer FRESENIUS KABI USA Active Ingredient Intravenous (IV) Fluids(in truh VEE nuhs FLOO ids) Pronunciation SO-dee-um KLOR-ide and poe-TASS-ee-um KLOR-ide
It is used to give fluids to the body when more fluids and electrolytes are needed.It is used as a way to give other drugs as a shot.It may be given to you for other reasons. Talk with the doctor.
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Drug Class
Fluid and Electrolyte Replenisher
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Pharmacologic Class
Hypotonic Crystalloid Solution; Electrolyte Supplement
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Pregnancy Category
Category C
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FDA Approved
Jan 1970
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DEA Schedule
Not Controlled

Overview

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What is this medicine?

This medication is an intravenous (IV) fluid, meaning it's given directly into your vein. It's a mixture of water, salt (sodium chloride), and potassium. It's used to help your body get enough fluids and to balance important salts (electrolytes) that your body needs to work properly, especially if you are dehydrated or have low levels of these salts.
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How to Use This Medicine

Proper Use of This Medication

To use this medication correctly, follow your doctor's instructions and read all the information provided. This medication is administered as an infusion into a vein over a period of time. Your doctor may instruct you on how to self-administer this medication.

Before and after handling the medication, wash your hands thoroughly. Do not use the medication if the solution appears cloudy, is leaking, or contains particles. Additionally, do not use the solution if it has changed color.

To dispose of used needles and other sharp objects, use a needle/sharp disposal box. Never reuse needles or other items. When the disposal box is full, follow local regulations for proper disposal. If you have any questions or concerns, consult your doctor or pharmacist.

Storage and Disposal

Typically, this medication is administered in a hospital or doctor's office. If you need to store it at home, follow the storage instructions provided by your doctor.

Missed Dose

If you miss a dose, contact your doctor to determine the best course of action.
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Lifestyle & Tips

  • This medication is administered in a healthcare setting. No specific lifestyle changes are required during administration, but your healthcare provider will monitor your fluid intake and output.
  • Report any unusual symptoms or discomfort immediately to your nurse or doctor.
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Available Forms & Alternatives

Available Strengths:

Dosing & Administration

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Adult Dosing

Standard Dose: Highly individualized based on patient's fluid and electrolyte status, body weight, age, and clinical condition. Typical infusion rates vary from 40 mL/hour to 250 mL/hour or more, depending on hydration needs and electrolyte deficits.

Condition-Specific Dosing:

dehydration: Rate and volume adjusted to correct fluid deficit and maintain hydration.
electrolyte_depletion: Rate and volume adjusted to correct sodium and potassium deficits, guided by serum electrolyte levels.
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Pediatric Dosing

Neonatal: Highly individualized based on weight, gestational age, fluid balance, and electrolyte status. Careful monitoring is essential due to immature renal function and smaller fluid compartments.
Infant: Highly individualized based on weight, fluid balance, and electrolyte status. Close monitoring of serum electrolytes and fluid input/output is crucial.
Child: Highly individualized based on weight, fluid balance, and electrolyte status. Typical maintenance fluid rates are calculated based on body weight (e.g., Holliday-Segar method), with adjustments for deficits or ongoing losses.
Adolescent: Highly individualized based on weight, fluid balance, and electrolyte status. Dosing approaches similar to adults, but with careful consideration of growth and development.
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Dose Adjustments

Renal Impairment:

Mild: Use with caution; monitor serum electrolytes (especially potassium and sodium) and fluid balance closely.
Moderate: Use with caution; significant risk of hyperkalemia and hypernatremia. Reduce infusion rate and volume, and monitor serum electrolytes and fluid balance frequently.
Severe: Contraindicated or used with extreme caution and close monitoring due to high risk of hyperkalemia, hypernatremia, and fluid overload. Consider alternative fluid management strategies.
Dialysis: Contraindicated or used with extreme caution and close monitoring. Fluid and electrolyte management should be guided by dialysis schedule and patient's interdialytic weight gain and electrolyte status.

Hepatic Impairment:

Mild: Generally no specific dose adjustment required, but monitor fluid balance due to potential for ascites or edema.
Moderate: Monitor fluid balance closely due to increased risk of fluid retention and ascites. Adjust rate as needed to prevent overload.
Severe: Monitor fluid balance and serum electrolytes closely due to significant risk of fluid retention, ascites, and electrolyte disturbances. Use with caution.

Pharmacology

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Mechanism of Action

0.45% Sodium Chloride (half-normal saline) provides free water, sodium, and chloride ions. It is a hypotonic solution relative to plasma, causing fluid to shift from the intravascular space into the intracellular and interstitial compartments, aiding in cellular rehydration. The addition of 20 mEq Potassium Chloride provides potassium ions, an essential intracellular cation, crucial for nerve impulse transmission, muscle contraction, and maintenance of normal renal function and acid-base balance. The solution helps to restore fluid and electrolyte balance, maintain plasma volume, and support normal physiological functions.
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Pharmacokinetics

Absorption:

Bioavailability: 100% (intravenous administration)
Tmax: Immediate
FoodEffect: Not applicable (IV administration)

Distribution:

Vd: Distributes primarily throughout the extracellular fluid compartment (interstitial and intravascular spaces). Free water distributes throughout total body water.
ProteinBinding: Not applicable (ions)
CnssPenetration: Limited (ions do not readily cross intact blood-brain barrier, but water shifts can affect CNS)

Elimination:

HalfLife: Variable, dependent on fluid and electrolyte balance, renal function, and physiological needs. Ions are continuously exchanged and excreted.
Clearance: Primarily renal excretion, with reabsorption and secretion regulated to maintain homeostasis.
ExcretionRoute: Renal (urine), minor losses via sweat and feces.
Unchanged: 100% (ions are not chemically altered)
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Pharmacodynamics

OnsetOfAction: Immediate (upon infusion)
PeakEffect: Achieved during infusion, sustained as long as infusion continues and body's homeostatic mechanisms are functioning.
DurationOfAction: Variable, dependent on patient's fluid and electrolyte status, renal function, and ongoing losses. Effects persist as long as the solution is infused and for a period thereafter until the body re-establishes equilibrium.
Confidence: High

Safety & Warnings

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Side Effects

Serious Side Effects: Seek Medical Help Right Away

Although rare, some people may experience severe and potentially life-threatening side effects while taking this medication. If you notice any of the following symptoms, contact your doctor immediately or seek medical attention:

Signs of an allergic reaction, such as:
+ Rash
+ Hives
+ Itching
+ Red, swollen, blistered, or peeling skin with or without fever
+ Wheezing
+ Tightness in the chest or throat
+ Trouble breathing, swallowing, or talking
+ Unusual hoarseness
+ Swelling of the mouth, face, lips, tongue, or throat
 Signs of fluid and electrolyte problems, such as:
+ Mood changes
+ Confusion
+ Muscle pain or weakness
+ Fast or abnormal heartbeat
+ Severe dizziness or passing out
+ Increased thirst
+ Seizures
+ Feeling very tired or weak
+ Decreased appetite
+ Unable to pass urine or change in the amount of urine produced
+ Dry mouth
+ Dry eyes
+ Severe upset stomach or vomiting
Signs of skin infection, such as:
+ Oozing
+ Heat
+ Swelling
+ Redness
+ Pain
 Swelling, warmth, numbness, change of color, or pain in a leg or arm
Chest pain or pressure
 Fever
Shortness of breath
 Sudden weight gain
Swelling in the arms or legs

Other Possible Side Effects

Like all medications, this drug can cause side effects. While many people may not experience any side effects or only minor ones, it's essential to discuss any concerns with your doctor. If you experience any of the following side effects or any other unusual symptoms, contact your doctor for advice:

 Irritation or swelling at the injection site
* Pain at the injection site

Reporting Side Effects

This list is not exhaustive, and you may experience other side effects not mentioned here. If you have questions or concerns about side effects, consult your doctor. You can also report side effects to the FDA at 1-800-332-1088 or online at https://www.fda.gov/medwatch.
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Seek Immediate Medical Attention If You Experience:

  • Swelling in your hands, ankles, or feet (edema)
  • Difficulty breathing or shortness of breath
  • Rapid weight gain
  • Muscle weakness or cramps
  • Irregular heartbeat or palpitations
  • Confusion, dizziness, or unusual tiredness
  • Headache or nausea
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Before Using This Medicine

Before Taking This Medication: Important Information to Share with Your Doctor

It is essential to inform your doctor about the following:

Any allergies you have, including allergies to this medication, its components, or other substances, such as foods or drugs. Be sure to describe the symptoms you experienced as a result of the allergy.
 Potential interactions with other medications or health conditions. This medication may affect or be affected by other drugs or health problems, so it is crucial to disclose all relevant information.

To ensure safe treatment, provide your doctor and pharmacist with a comprehensive list of:

All prescription and over-the-counter (OTC) medications you are taking
 Natural products and vitamins you are using
* Any health problems you have

Carefully review your medications and health conditions to confirm that it is safe to take this medication in conjunction with them. Never start, stop, or adjust the dosage of any medication without first consulting your doctor.
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Precautions & Cautions

It is essential to inform all your healthcare providers, including doctors, nurses, pharmacists, and dentists, that you are taking this medication.

If your medication contains potassium, consult your doctor before using any salt substitutes or products that have potassium in them.

For medications containing dextrose, if you have diabetes (high blood sugar), discuss this with your doctor to ensure safe use.

Regular blood tests are crucial while taking this medication. Follow your doctor's instructions for scheduling these tests and discuss the results with them.

When administering this medication to newborns, exercise caution due to a potentially higher risk of side effects in this age group.

If you are pregnant, planning to become pregnant, or are breastfeeding, notify your doctor. It is crucial to discuss the benefits and risks of this medication for both you and your baby to make an informed decision.
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Overdose Information

Overdose Symptoms:

  • Fluid overload (pulmonary edema, peripheral edema, hypertension, heart failure)
  • Hyperkalemia (muscle weakness, paresthesias, fatigue, bradycardia, ECG changes)
  • Hypernatremia (thirst, lethargy, confusion, seizures, coma)
  • Metabolic acidosis (due to chloride load in large volumes)

What to Do:

Immediate medical attention is required. Management involves discontinuing the infusion, administering diuretics for fluid overload, administering glucose and insulin or calcium gluconate for hyperkalemia, and other supportive measures as indicated. Call 1-800-222-1222 (Poison Control) for specific guidance.

Drug Interactions

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Major Interactions

  • ACE inhibitors (e.g., lisinopril, enalapril): Increased risk of hyperkalemia due to reduced aldosterone secretion.
  • Angiotensin Receptor Blockers (ARBs) (e.g., valsartan, losartan): Increased risk of hyperkalemia.
  • Potassium-sparing diuretics (e.g., spironolactone, amiloride, triamterene): Significant increased risk of severe hyperkalemia.
  • Non-steroidal anti-inflammatory drugs (NSAIDs): May impair renal potassium excretion, increasing hyperkalemia risk.
  • Cyclosporine, Tacrolimus: May increase risk of hyperkalemia.
  • Digoxin: Hyperkalemia can antagonize the effects of digoxin, while hypokalemia (if present before infusion) can potentiate digoxin toxicity. Careful monitoring is needed.
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Moderate Interactions

  • Corticosteroids (e.g., prednisone, hydrocortisone): May cause sodium and fluid retention, increasing risk of hypernatremia and fluid overload.
  • Other diuretics (e.g., loop diuretics, thiazide diuretics): May alter sodium and potassium balance, requiring careful monitoring.
  • Lithium: Sodium intake can affect lithium excretion; changes in sodium levels can alter lithium levels.

Monitoring

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Baseline Monitoring

Serum Electrolytes (Na, K, Cl)

Rationale: To assess baseline fluid and electrolyte status and guide initial infusion rate and composition.

Timing: Prior to initiation of therapy.

Renal Function (BUN, Creatinine)

Rationale: To assess kidney's ability to excrete excess fluid and electrolytes, guiding safe administration.

Timing: Prior to initiation of therapy.

Fluid Status (Weight, Vital Signs, Edema assessment)

Rationale: To establish baseline hydration status and identify signs of fluid overload or dehydration.

Timing: Prior to initiation of therapy.

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Routine Monitoring

Serum Electrolytes (Na, K, Cl)

Frequency: Every 4-24 hours, or as clinically indicated, especially during initial therapy or in unstable patients.

Target: Sodium: 135-145 mEq/L; Potassium: 3.5-5.0 mEq/L; Chloride: 98-107 mEq/L

Action Threshold: Values outside normal range, particularly hyperkalemia (>5.5 mEq/L) or significant hyponatremia/hypernatremia, require immediate intervention (e.g., adjusting infusion rate, stopping infusion, administering corrective agents).

Fluid Input and Output (I&O)

Frequency: Every 4-8 hours, or continuously in critically ill patients.

Target: Balanced I&O, or appropriate positive/negative balance based on clinical goals.

Action Threshold: Significant positive or negative fluid balance, indicating fluid overload or persistent dehydration, requires adjustment of fluid therapy.

Body Weight

Frequency: Daily, or more frequently in critically ill patients.

Target: Stable weight, or appropriate changes based on clinical goals.

Action Threshold: Rapid weight gain (>1-2 kg/day) suggesting fluid overload, or persistent weight loss suggesting inadequate hydration.

Vital Signs (BP, HR, RR)

Frequency: Every 4-8 hours, or more frequently as clinically indicated.

Target: Within patient's normal range.

Action Threshold: Changes indicative of fluid overload (e.g., elevated BP, crackles, dyspnea) or dehydration (e.g., orthostatic hypotension, tachycardia).

Renal Function (BUN, Creatinine)

Frequency: Every 24-48 hours, or as clinically indicated, especially in patients with impaired renal function.

Target: Stable or improving.

Action Threshold: Rising BUN/Creatinine may indicate worsening renal function or inadequate hydration; significant changes require re-evaluation of fluid therapy.

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Symptom Monitoring

  • Signs of fluid overload: peripheral edema, pulmonary crackles, dyspnea, jugular venous distention, rapid weight gain.
  • Signs of hyperkalemia: muscle weakness, paresthesias, fatigue, bradycardia, ECG changes (peaked T waves, widened QRS).
  • Signs of hypernatremia: thirst, lethargy, confusion, seizures, coma.
  • Signs of hyponatremia (if excessive free water is given without adequate sodium): headache, nausea, vomiting, confusion, seizures.
  • Signs of hypokalemia (if inadequate potassium is given for needs): muscle weakness, cramps, fatigue, constipation, arrhythmias.

Special Patient Groups

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Pregnancy

Generally considered safe for use during pregnancy when clinically indicated for fluid and electrolyte replacement. However, careful monitoring of fluid and electrolyte balance is essential to avoid complications such as fluid overload or electrolyte imbalances in both mother and fetus.

Trimester-Specific Risks:

First Trimester: No known specific risks, but fluid and electrolyte balance should be carefully managed.
Second Trimester: No known specific risks, but fluid and electrolyte balance should be carefully managed.
Third Trimester: No known specific risks, but careful monitoring for fluid overload is important, especially in pre-eclampsia or other conditions predisposing to edema.
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Lactation

Considered safe for use during lactation. Sodium, potassium, and chloride are normal components of breast milk and are essential for infant nutrition. Administration of these fluids to the mother is unlikely to cause adverse effects in the breastfed infant.

Infant Risk: Low risk.
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Pediatric Use

Use with extreme caution and precise calculation of fluid and electrolyte needs. Pediatric patients, especially neonates and infants, have immature renal function, smaller fluid compartments, and higher metabolic rates, making them more susceptible to fluid overload, electrolyte imbalances (hyperkalemia, hyponatremia), and cerebral edema. Close monitoring of fluid input/output, body weight, and serum electrolytes is critical.

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Geriatric Use

Use with caution. Elderly patients are more prone to fluid overload due to decreased renal and cardiac reserve. They may also have pre-existing conditions (e.g., heart failure, renal impairment) that increase the risk of electrolyte imbalances (hyperkalemia, hypernatremia) and fluid retention. Close monitoring of fluid status, electrolytes, and renal function is essential.

Clinical Information

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Clinical Pearls

  • This solution is hypotonic (0.45% NaCl) and provides free water, making it suitable for cellular rehydration in conditions like hypernatremia or pure water deficit. However, it should be used cautiously to avoid hyponatremia if not indicated.
  • The addition of potassium chloride (20 mEq/L) makes this solution useful for patients with ongoing potassium losses or mild hypokalemia, but requires careful monitoring to prevent hyperkalemia, especially in patients with impaired renal function or those on potassium-sparing medications.
  • Always assess the patient's overall fluid and electrolyte status, including serum osmolality, before initiating and throughout therapy.
  • Avoid rapid infusion, especially in patients at risk for fluid overload (e.g., heart failure, renal impairment) or cerebral edema.
  • Not suitable for rapid volume expansion or in situations requiring isotonic solutions (e.g., hypovolemic shock).
  • Ensure patency of the IV line and monitor for signs of infiltration or phlebitis at the infusion site.
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Alternative Therapies

  • Oral rehydration solutions (for mild to moderate dehydration without severe electrolyte imbalance)
  • Other IV fluid types (e.g., isotonic crystalloids for volume expansion, hypertonic saline for severe hyponatremia)
  • Specific electrolyte replacement (e.g., oral potassium supplements, IV potassium chloride infusions for severe hypokalemia without need for large volume fluid replacement).
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Cost & Coverage

Average Cost: Varies widely by volume (e.g., $5 - $50+) per 1000 mL bag
Generic Available: Yes
Insurance Coverage: Generally covered by most health insurance plans as a medical supply or part of hospital/clinic treatment.
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General Drug Facts

If your symptoms or health problems persist or worsen, it is essential to contact your doctor promptly. To ensure safe use, never share your medication with others, and do not take medication prescribed for someone else. Store all medications in a secure location, out of reach of children and pets, to prevent accidental ingestion. Dispose of unused or expired medications properly. Unless instructed to do so by a healthcare professional, do not flush medications down the toilet or pour them down the drain. If you are unsure about the proper disposal method, consult your pharmacist, who can also inform you about potential drug take-back programs in your area. Some medications may come with an additional patient information leaflet, which your pharmacist can provide. If you have any questions or concerns about your medication, discuss them with your doctor, nurse, pharmacist, or other healthcare provider. In the event of a suspected overdose, immediately call your local poison control center or seek emergency medical attention. Be prepared to provide information about the medication taken, the amount, and the time it was taken to ensure timely and effective treatment.