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Sod Chloride 0.45% Inj, 1000ml

Manufacturer B. BRAUN MCGAW Active Ingredient Intravenous (IV) Fluids(in truh VEE nuhs FLOO ids) Pronunciation SO-dee-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; Plasma Volume Expander
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Pharmacologic Class
Hypotonic Crystalloid Solution; Electrolyte
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Pregnancy Category
Category B
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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 (IV). It contains water and small amounts of salt (sodium chloride). It's used to replace fluids and salts your body might be missing, especially when you're dehydrated or need extra water inside your cells. It helps keep your body's fluid balance correct.
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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 by healthcare professionals in a clinical setting.
  • Report any discomfort at the IV site (pain, swelling, redness) immediately.
  • Report any new or worsening symptoms such as shortness of breath, swelling in your ankles or feet, headache, confusion, or unusual tiredness.
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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, age, weight, and clinical condition. Typical infusion rates range from 75-150 mL/hour, but can be much higher in acute dehydration or lower for maintenance.
Dose Range: 50 - 500 mg

Condition-Specific Dosing:

maintenance_fluid: Typically 75-125 mL/hour
dehydration_correction: Up to 500 mL/hour or more depending on severity and patient tolerance, with close monitoring.
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Pediatric Dosing

Neonatal: Dosing is highly individualized based on weight, gestational age, and clinical needs. Typically 2-4 mL/kg/hour for maintenance, adjusted for specific conditions.
Infant: Dosing is highly individualized based on weight and clinical needs. Typically 2-4 mL/kg/hour for maintenance, adjusted for specific conditions.
Child: Dosing is highly individualized based on weight and clinical needs. Typically 2-4 mL/kg/hour for maintenance, adjusted for specific conditions.
Adolescent: Dosing is highly individualized based on weight and clinical needs. Typically 2-4 mL/kg/hour for maintenance, adjusted for specific conditions, or adult dosing if appropriate.
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Dose Adjustments

Renal Impairment:

Mild: Use with caution; monitor fluid balance and serum electrolytes closely.
Moderate: Use with caution; monitor fluid balance and serum electrolytes closely. Reduced rates may be necessary to prevent fluid overload.
Severe: Contraindicated or use with extreme caution and reduced rates; risk of fluid overload and electrolyte imbalance (especially hypernatremia or hyponatremia if free water is not handled well). Close monitoring of fluid balance, electrolytes, and renal function is essential.
Dialysis: Use with extreme caution; fluid and electrolyte management is complex in dialysis patients. Dosing must be precisely controlled based on interdialytic weight gain and serum electrolyte levels.

Hepatic Impairment:

Mild: Use with caution; monitor fluid balance and serum electrolytes closely, especially in patients with ascites or edema.
Moderate: Use with caution; monitor fluid balance and serum electrolytes closely. Increased risk of fluid retention and electrolyte disturbances.
Severe: Use with extreme caution; significant risk of fluid overload, ascites, and electrolyte imbalances (e.g., dilutional hyponatremia). Close monitoring of fluid balance and electrolytes is critical.

Pharmacology

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Mechanism of Action

0.45% Sodium Chloride Injection (half-normal saline) is a hypotonic crystalloid solution. It provides water, sodium, and chloride ions. When infused intravenously, it expands the extracellular fluid compartment, including the interstitial and intravascular spaces. Because it is hypotonic relative to plasma, it provides more free water than 0.9% Sodium Chloride, allowing water to shift from the extracellular space into the intracellular space, thus hydrating cells. It is used to replace fluid and electrolytes, particularly when free water is needed to correct hypernatremia or cellular dehydration.
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Pharmacokinetics

Absorption:

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

Distribution:

Vd: Approximately 0.2 L/kg (distributes throughout the extracellular fluid space)
ProteinBinding: Not applicable (ions do not bind to plasma proteins)
CnssPenetration: Yes (ions cross the blood-brain barrier, but slower than water)

Elimination:

HalfLife: Not applicable (ions are continuously exchanged and regulated)
Clearance: Primarily renal excretion, regulated by kidney function and hormonal control (e.g., aldosterone, ADH)
ExcretionRoute: Renal (urine), sweat, feces
Unchanged: 100% (ions are not chemically altered)
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Pharmacodynamics

OnsetOfAction: Immediate (upon infusion)
PeakEffect: During infusion, depending on rate and volume
DurationOfAction: Dependent on infusion rate, volume, and patient's fluid and electrolyte status; effects persist as long as fluid is present in the extracellular space and until renal excretion or cellular shifts occur.
Confidence: Medium

Safety & Warnings

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Side Effects

Urgent 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 immediate 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, including:
+ Mood changes
+ Confusion
+ Muscle pain or weakness
+ Fast or abnormal heartbeat
+ Severe dizziness or fainting
+ Increased thirst
+ Seizures
+ Feeling very tired or weak
+ Decreased appetite
+ Unable to pass urine or changes in urine production
+ Dry mouth
+ Dry eyes
+ Severe stomach upset or vomiting
Signs of skin infection, such as:
+ Oozing
+ Heat
+ Swelling
+ Redness
+ Pain
 Swelling, warmth, numbness, color changes, 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. Many people experience no side effects or only mild ones. If you notice any of the following side effects or any other symptoms that concern you or do not go away, contact your doctor:

 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 about side effects, contact 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:

  • Shortness of breath or difficulty breathing
  • Swelling in the face, hands, ankles, or feet
  • Rapid weight gain
  • Headache, confusion, or dizziness
  • Nausea or vomiting
  • Muscle cramps or weakness
  • Seizures
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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 this 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 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 with your doctor before using any salt substitutes or products that also contain 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 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, it is crucial to discuss the benefits and risks of this medication with your doctor to make an informed decision regarding your health and the health of your baby.
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Overdose Information

Overdose Symptoms:

  • Fluid overload (edema, pulmonary congestion, hypertension)
  • Hypernatremia (excess sodium: thirst, lethargy, confusion, seizures, coma)
  • Hyponatremia (low sodium, if given inappropriately or in specific conditions: headache, nausea, seizures, cerebral edema)
  • Electrolyte imbalances

What to Do:

Discontinue infusion, administer diuretics if fluid overload, correct electrolyte imbalances, provide supportive care. Call 1-800-222-1222 (Poison Control) or seek immediate medical attention.

Drug Interactions

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Major Interactions

  • Corticosteroids (e.g., Prednisone, Hydrocortisone): May increase sodium and fluid retention, leading to edema and hypertension.
  • Lithium: Changes in sodium balance can affect lithium excretion, potentially leading to lithium toxicity or decreased efficacy. Close monitoring of lithium levels is required.
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Moderate Interactions

  • Diuretics (e.g., Furosemide, Hydrochlorothiazide): May alter fluid and electrolyte balance, requiring careful monitoring to avoid over-correction or exacerbation of imbalances.
  • Drugs that cause sodium retention (e.g., NSAIDs): May increase risk of fluid overload and edema.

Monitoring

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Baseline Monitoring

Serum Electrolytes (Na+, K+, Cl-)

Rationale: To establish baseline electrolyte status and identify pre-existing imbalances.

Timing: Prior to initiation of therapy

Renal Function (BUN, Creatinine)

Rationale: To assess kidney's ability to handle fluid and electrolytes.

Timing: Prior to initiation of therapy

Fluid Status (Weight, Vital Signs, Edema assessment)

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

Timing: Prior to initiation of therapy

Urine Output

Rationale: To assess renal perfusion and fluid excretion capacity.

Timing: Prior to initiation of therapy

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Routine Monitoring

Fluid Balance (Intake and Output)

Frequency: Every 4-8 hours or continuously

Target: Appropriate balance based on clinical need

Action Threshold: Significant positive or negative balance; signs of fluid overload or dehydration

Serum Electrolytes (Na+, K+, Cl-)

Frequency: Every 12-24 hours, or more frequently as clinically indicated (e.g., every 4-6 hours in critical patients)

Target: Na: 135-145 mEq/L; K: 3.5-5.0 mEq/L; Cl: 98-106 mEq/L

Action Threshold: Sodium <130 mEq/L or >150 mEq/L; significant changes from baseline; signs of electrolyte imbalance

Vital Signs (BP, HR, RR)

Frequency: Every 4 hours or more frequently

Target: Within patient's normal limits

Action Threshold: Significant changes indicating fluid overload (e.g., hypertension, tachycardia) or dehydration (e.g., hypotension, tachycardia)

Weight

Frequency: Daily

Target: Stable or desired change

Action Threshold: Rapid weight gain (>1-2 kg/day) or loss

Physical Assessment (Edema, Lung Sounds, Skin Turgor)

Frequency: Every 8-12 hours or as needed

Target: No new or worsening edema, clear lung sounds, normal skin turgor

Action Threshold: New or worsening peripheral/pulmonary edema, crackles, decreased skin turgor

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Symptom Monitoring

  • Signs of fluid overload: dyspnea, orthopnea, peripheral edema, crackles on lung auscultation, jugular venous distension, hypertension.
  • Signs of hyponatremia: headache, nausea, vomiting, lethargy, confusion, seizures, muscle cramps.
  • Signs of hypernatremia: thirst, dry mucous membranes, restlessness, irritability, lethargy, seizures, coma.
  • Signs of other electrolyte imbalances: muscle weakness, cardiac arrhythmias.

Special Patient Groups

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Pregnancy

Sodium chloride 0.45% injection is generally considered safe for use during pregnancy when clinically indicated for fluid and electrolyte replacement. It is a physiological solution. Close monitoring of fluid and electrolyte status is recommended.

Trimester-Specific Risks:

First Trimester: No known specific risks.
Second Trimester: No known specific risks.
Third Trimester: No known specific risks, but caution with fluid overload in pre-eclampsia or other conditions.
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Lactation

Sodium chloride 0.45% injection is considered safe for use during lactation. Sodium and chloride are normal components of breast milk, and administration of this solution is not expected to harm the nursing infant.

Infant Risk: Low (L1)
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Pediatric Use

Use with extreme caution in neonates and infants due to immature renal function and higher risk of fluid and electrolyte imbalances, especially hyponatremia or hypernatremia. Dosing must be precisely calculated based on weight and clinical status. Close monitoring of fluid balance, electrolytes, and vital signs is crucial.

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Geriatric Use

Use with caution in elderly patients due to age-related decline in renal function, increased risk of cardiovascular disease, and propensity for fluid overload or electrolyte imbalances. Start with lower infusion rates and monitor fluid balance and electrolytes closely.

Clinical Information

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Clinical Pearls

  • 0.45% Sodium Chloride is a hypotonic solution, meaning it provides free water to hydrate cells. It is often used for maintenance fluids or to treat hypernatremia.
  • Always monitor serum sodium levels closely when administering hypotonic solutions to prevent hyponatremia, especially in pediatric patients, patients with head trauma, or those at risk for SIADH.
  • Avoid rapid infusion, particularly in patients at risk for cerebral edema (e.g., severe hyponatremia, head injury) or fluid overload (e.g., heart failure, renal impairment).
  • This solution does not provide significant caloric support or essential nutrients.
  • Assess for signs of fluid overload (e.g., pulmonary crackles, peripheral edema, elevated blood pressure) and electrolyte imbalances throughout therapy.
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Alternative Therapies

  • 0.9% Sodium Chloride Injection (Normal Saline): Isotonic, primarily for extracellular volume expansion.
  • Lactated Ringer's Injection: Isotonic, contains multiple electrolytes and lactate (bicarbonate precursor), often used for volume resuscitation.
  • Dextrose 5% in Water (D5W): Isotonic in the bag, but becomes hypotonic in the body as dextrose is metabolized, providing free water.
  • Dextrose 5% in 0.9% Sodium Chloride (D5NS): Isotonic, provides some free water after dextrose metabolism.
  • Dextrose 5% in 0.45% Sodium Chloride (D5 1/2 NS): Hypotonic, provides free water and some calories.
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Cost & Coverage

Average Cost: $5 - $20 per 1000ml bag
Generic Available: Yes
Insurance Coverage: Tier 1 (Preferred Generic) or covered under medical benefit for inpatient/outpatient administration.
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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, 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 for guidance. Many communities have drug take-back programs, which your pharmacist can help you locate. Some medications may come with an additional patient information leaflet; check with your pharmacist to see if this applies to your prescription. 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 prompt and effective treatment.