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Sod Chloride 0.45%/20meqkcl

Manufacturer BAXTER HEALTHCARE CORP Active Ingredient Intravenous (IV) Fluids(in truh VEE nuhs FLOO ids) Pronunciation SO-dee-um KLOR-ide (point four five per-SENT) with TWEN-tee mil-ee-EK-wee-val-ents po-TAS-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
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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 a sterile liquid given through a vein (intravenously) to help your body get enough water, salt, and potassium. It's used when you're dehydrated or need to maintain your body's fluid and electrolyte balance, especially if you can't drink enough fluids by mouth.
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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 administer it yourself. Before and after handling the medication, wash your hands thoroughly.

Important Administration Instructions

Do not use the medication if the solution appears cloudy, is leaking, or contains particles.
 Do not use the medication if the solution has changed color.
Dispose of needles and sharp objects in a designated 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

  • Report any discomfort or pain at the IV site immediately.
  • Inform your healthcare provider if you experience swelling, difficulty breathing, or unusual weakness during or after the infusion.
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Available Forms & Alternatives

Available Strengths:

Dosing & Administration

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Adult Dosing

Standard Dose: Individualized based on patient's fluid and electrolyte requirements, clinical condition, and laboratory values.

Condition-Specific Dosing:

dehydration: Typically administered at rates to restore fluid balance, e.g., 100-250 mL/hour, adjusted as needed.
maintenance: Typically 40-125 mL/hour, adjusted based on patient's daily fluid and electrolyte needs.
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Pediatric Dosing

Neonatal: Dosing is highly individualized based on weight, gestational age, fluid status, and electrolyte balance. Careful monitoring is essential.
Infant: Dosing is highly individualized based on weight, fluid status, and electrolyte balance. Careful monitoring is essential.
Child: Dosing is highly individualized based on weight, fluid status, and electrolyte balance. Careful monitoring is essential.
Adolescent: Dosing is highly individualized based on weight, fluid status, and electrolyte balance. Careful monitoring is essential.
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Dose Adjustments

Renal Impairment:

Mild: Use with caution; monitor fluid and electrolyte status closely.
Moderate: Use with caution; monitor fluid and electrolyte status closely, especially potassium and sodium levels. Reduced infusion rates may be necessary.
Severe: Contraindicated in severe renal impairment with oliguria or anuria due to risk of fluid overload and hyperkalemia. If used, extreme caution and continuous monitoring are required.
Dialysis: Generally avoided or used with extreme caution in patients on dialysis due to risk of fluid overload and electrolyte imbalances. Consult nephrology.

Hepatic Impairment:

Mild: No specific dose adjustment typically required, but monitor for fluid retention.
Moderate: No specific dose adjustment typically required, but monitor for fluid retention and electrolyte imbalances, especially in ascites.
Severe: No specific dose adjustment typically required, but monitor for fluid retention and electrolyte imbalances, especially in ascites and hepatorenal syndrome.

Pharmacology

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Mechanism of Action

Sodium Chloride 0.45% provides free water, sodium, and chloride ions. The solution is hypotonic relative to plasma, allowing water to shift from the intravascular space into the intracellular and interstitial compartments, aiding in cellular rehydration. The addition of Potassium Chloride (20 mEq/L) provides potassium ions, an essential intracellular cation, crucial for nerve impulse transmission, muscle contraction, and maintenance of normal renal function and acid-base balance.
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Pharmacokinetics

Absorption:

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

Distribution:

Vd: Distributes throughout the extracellular fluid compartment (sodium and chloride) and intracellular compartment (potassium).
ProteinBinding: Not applicable (ions)
CnssPenetration: Yes (water and electrolytes cross the blood-brain barrier)

Elimination:

HalfLife: Not a typical drug half-life; depends on fluid balance, renal function, and homeostatic mechanisms.
Clearance: Primarily renal excretion; also via sweat and gastrointestinal tract.
ExcretionRoute: Renal, sweat, gastrointestinal
Unchanged: 100% (ions)
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Pharmacodynamics

OnsetOfAction: Immediate
PeakEffect: Immediate
DurationOfAction: Dependent on patient's fluid and electrolyte status, renal function, and rate of administration.

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 or seek medical attention immediately:

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, including:
+ 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. If you have questions or concerns, don't hesitate to reach out to 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, feet, or ankles (edema)
  • Difficulty breathing or shortness of breath
  • Unusual tiredness or muscle weakness
  • Irregular heartbeat or palpitations
  • Confusion or dizziness
  • Excessive thirst
  • Nausea or vomiting
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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, such as herbal supplements
Vitamins
 Any existing health problems

Carefully review your medications and health conditions with your doctor to confirm that it is safe to take this medication. Do not initiate, discontinue, 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 a salt substitute or any product that also contains potassium.

If your medication contains dextrose and you have diabetes (high blood sugar), discuss this with your doctor to ensure safe management of your condition.

Regular blood tests will be necessary as directed by your doctor. Be sure to follow their instructions and discuss any concerns or questions you may have.

When administering this medication to a newborn, exercise caution due to the potential for a 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 potential benefits and risks of this medication to both you and your baby to make an informed decision.
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Overdose Information

Overdose Symptoms:

  • Fluid overload (e.g., pulmonary edema, peripheral edema, hypertension)
  • Hypernatremia (e.g., thirst, lethargy, confusion, seizures, coma)
  • Hyperkalemia (e.g., muscle weakness, paresthesias, fatigue, bradycardia, cardiac arrhythmias, cardiac arrest)

What to Do:

Immediate discontinuation of infusion. Management is supportive and includes diuretics for fluid overload, and specific interventions for hyperkalemia (e.g., calcium gluconate, insulin/glucose, sodium bicarbonate, potassium-binding resins, dialysis) or hypernatremia (e.g., administration of free water). Call 1-800-222-1222 (Poison Control).

Drug Interactions

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Major Interactions

  • Potassium-sparing diuretics (e.g., spironolactone, amiloride, triamterene): Increased risk of severe hyperkalemia.
  • ACE inhibitors (e.g., lisinopril, enalapril): Increased risk of hyperkalemia.
  • Angiotensin Receptor Blockers (ARBs) (e.g., valsartan, losartan): Increased risk of hyperkalemia.
  • Non-steroidal anti-inflammatory drugs (NSAIDs): May impair renal potassium excretion, increasing hyperkalemia risk.
  • Cyclosporine, Tacrolimus: May increase risk of hyperkalemia.
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Moderate Interactions

  • Corticosteroids (e.g., prednisone, hydrocortisone): May cause sodium and fluid retention, potentially exacerbating fluid overload.
  • Lithium: Sodium intake can affect lithium excretion; monitor lithium levels.
  • Digoxin: Hypokalemia can potentiate digoxin toxicity; hyperkalemia can antagonize digoxin effects. Careful monitoring of potassium is crucial.
  • Other potassium-containing medications or supplements: Increased risk of hyperkalemia.

Monitoring

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Baseline Monitoring

Serum Electrolytes (Sodium, Potassium, Chloride)

Rationale: To establish baseline electrolyte status and guide initial fluid and electrolyte replacement.

Timing: Prior to initiation of therapy

Renal Function (BUN, Creatinine)

Rationale: To assess kidney's ability to excrete excess fluid and electrolytes, especially potassium.

Timing: Prior to initiation of therapy

Fluid Status (Weight, Vital Signs, Edema assessment)

Rationale: To assess baseline hydration status and risk of fluid overload.

Timing: Prior to initiation of therapy

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Routine Monitoring

Serum Electrolytes (Sodium, Potassium, Chloride)

Frequency: Every 4-24 hours, or as clinically indicated based on patient's condition and infusion rate.

Target: Sodium: 135-145 mEq/L; Potassium: 3.5-5.0 mEq/L; Chloride: 98-106 mEq/L

Action Threshold: Values outside normal range, especially hyperkalemia (>5.5 mEq/L) or significant hyponatremia (<130 mEq/L) or hypernatremia (>150 mEq/L).

Fluid Balance (Intake and Output, Daily Weight)

Frequency: Every 8-24 hours, or more frequently if rapid fluid shifts are expected.

Target: Appropriate balance based on clinical need (e.g., slightly positive for rehydration, neutral for maintenance).

Action Threshold: Significant positive fluid balance (e.g., >1-2 L/day) or rapid weight gain (>1-2 kg/day) indicating fluid overload; or persistent negative balance indicating inadequate hydration.

Vital Signs (Blood Pressure, Heart Rate, Respiratory Rate)

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

Target: Within patient's normal limits.

Action Threshold: Signs of fluid overload (e.g., elevated BP, crackles, dyspnea) or electrolyte imbalance (e.g., arrhythmias).

Clinical Assessment (Edema, Lung Sounds, Mental Status)

Frequency: Every 8-24 hours, or as clinically indicated.

Target: Absence of new or worsening edema, clear lung sounds, alert mental status.

Action Threshold: Development of peripheral or pulmonary edema, new onset dyspnea, altered mental status.

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Symptom Monitoring

  • Signs of fluid overload (e.g., peripheral edema, pulmonary crackles, dyspnea, jugular venous distension, rapid weight gain)
  • Symptoms of hyperkalemia (e.g., muscle weakness, paresthesias, fatigue, bradycardia, arrhythmias)
  • Symptoms of hypernatremia (e.g., thirst, lethargy, confusion, seizures, coma)
  • Symptoms of hyponatremia (e.g., headache, nausea, vomiting, confusion, seizures)
  • Signs of infusion site reactions (e.g., pain, redness, swelling, phlebitis)

Special Patient Groups

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Pregnancy

Generally considered safe for use during pregnancy when clinically indicated for fluid and electrolyte replacement. Careful monitoring of maternal fluid and electrolyte balance is essential.

Trimester-Specific Risks:

First Trimester: No known specific risks when used appropriately.
Second Trimester: No known specific risks when used appropriately.
Third Trimester: No known specific risks when used appropriately. Monitor for fluid overload, especially in pre-eclampsia.
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Lactation

Considered safe for use during lactation. The components (water, sodium, potassium, chloride) are naturally present in breast milk and are essential for infant nutrition. Administration of this solution is unlikely to cause adverse effects in the breastfed infant.

Infant Risk: Low risk
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Pediatric Use

Requires careful calculation of fluid and electrolyte needs based on body weight, age, and clinical condition. Pediatric patients, especially neonates and infants, have immature renal function and are more susceptible to fluid overload and electrolyte imbalances (e.g., hyponatremia, hyperkalemia). Close monitoring of fluid intake/output, weight, and serum electrolytes is crucial.

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Geriatric Use

Elderly patients are at increased risk of fluid overload due to age-related decline in renal and cardiac function. They may also have pre-existing conditions or medications that predispose them to electrolyte imbalances (e.g., hyperkalemia with ACEIs/ARBs). Close monitoring of fluid status, renal function, and electrolytes is essential. Lower infusion rates may be necessary.

Clinical Information

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Clinical Pearls

  • This solution is hypotonic (0.45% NaCl) and provides free water, making it suitable for patients with hypernatremia or those needing maintenance fluids where free water is desired.
  • The 20 mEq KCl/L provides a moderate amount of potassium. Always confirm patient's potassium levels and renal function before and during administration to avoid hyperkalemia.
  • Not suitable for rapid volume expansion or resuscitation, as it is hypotonic and will shift fluid out of the intravascular space.
  • Avoid in patients with severe hyperkalemia, severe renal impairment (oliguria/anuria), or conditions where sodium retention is detrimental (e.g., severe heart failure, severe edema).
  • Always inspect the solution for particulate matter and discoloration prior to administration. Do not use if cloudy or discolored.
  • Administer via a controlled infusion device to ensure accurate flow rate, especially in pediatric and elderly patients.
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Alternative Therapies

  • Oral rehydration solutions (for mild dehydration)
  • Other intravenous crystalloid solutions (e.g., 0.9% NaCl, Lactated Ringer's, Dextrose solutions)
  • Colloid solutions (e.g., albumin, for specific volume expansion needs)
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Cost & Coverage

Average Cost: $5 - $20 per 1000 mL bag
Generic Available: Yes
Insurance Coverage: Generally covered by most health insurance plans as it is a standard hospital-administered medication.
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General Drug Facts

If your symptoms or health problems persist or worsen, it is essential to contact your doctor for further guidance. 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, avoid flushing medications down the toilet or pouring 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 contact your local poison control center or seek medical attention. Be prepared to provide information about the medication taken, the amount, and the time of ingestion to ensure prompt and effective treatment.