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Sod Chloride 0.45% Inj, 500ml

Manufacturer BAXTER 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 replacement
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Pharmacologic Class
Electrolyte solution; Crystalloid
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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 salt water solution given directly into your vein (intravenously). It's used to help your body get enough water and salt, especially if you are dehydrated or need fluids for other medical reasons. It helps keep your body's fluid balance in check.
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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 at the IV site (pain, swelling, redness).
  • Report any changes in how you feel, such as shortness of breath, swelling in your ankles, or unusual thirst.
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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. Typically administered as a continuous infusion.

Condition-Specific Dosing:

maintenance_fluid: Typically 40-100 mL/hour, adjusted based on clinical need and electrolyte monitoring.
dehydration: Higher rates may be used for rehydration, but careful monitoring is essential to avoid fluid overload and electrolyte imbalances, especially hyponatremia.
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Pediatric Dosing

Neonatal: Dosing is highly individualized based on body weight, gestational age, fluid and electrolyte balance, and clinical condition. Careful monitoring is crucial due to immature renal function and smaller fluid compartments.
Infant: Dosing is highly individualized based on body weight, fluid and electrolyte balance, and clinical condition. Careful monitoring is crucial.
Child: Dosing is highly individualized based on body weight, fluid and electrolyte balance, and clinical condition. Careful monitoring is crucial.
Adolescent: Dosing is highly individualized based on body weight, fluid and electrolyte balance, and clinical condition. Careful monitoring is crucial.
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Dose Adjustments

Renal Impairment:

Mild: Use with caution; monitor fluid balance and electrolytes closely.
Moderate: Use with caution; monitor fluid balance and electrolytes closely. Reduced infusion rates may be necessary to prevent fluid overload.
Severe: Contraindicated or use with extreme caution; significant risk of fluid overload and electrolyte disturbances (e.g., hypernatremia, hyperchloremia, metabolic acidosis). Close monitoring and potentially dialysis may be required.
Dialysis: Administer with extreme caution and only if clinically indicated, as patients on dialysis have impaired fluid and electrolyte regulation. Fluid removal during dialysis must be considered.

Hepatic Impairment:

Mild: Use with caution; monitor fluid balance and electrolytes closely due to potential for fluid retention.
Moderate: Use with caution; monitor fluid balance and electrolytes closely. Increased risk of fluid retention and ascites.
Severe: Use with extreme caution; significant risk of fluid overload, ascites, and electrolyte disturbances. Close monitoring is essential.

Pharmacology

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Mechanism of Action

0.45% Sodium Chloride Injection is a hypotonic crystalloid solution. It provides water and electrolytes (sodium and chloride) to the extracellular fluid compartment. The hypotonicity allows water to shift from the extracellular space into the intracellular space, aiding in cellular rehydration. It helps to restore fluid volume, maintain osmotic pressure, and provide essential electrolytes for normal physiological function.
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Pharmacokinetics

Absorption:

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

Distribution:

Vd: Approximately 0.2 L/kg (extracellular fluid volume)
ProteinBinding: Not applicable (ions)
CnssPenetration: Limited (ions do not readily cross intact blood-brain barrier, but water shifts can occur)

Elimination:

HalfLife: Not applicable (ions are continuously exchanged and regulated)
Clearance: Primarily renal excretion, regulated by kidneys to maintain fluid and electrolyte balance.
ExcretionRoute: Renal
Unchanged: Not applicable (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. Typically short-lived as fluid is distributed and excreted.

Safety & Warnings

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Side Effects

Serious Side Effects: Seek Medical Help Immediately

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 right away:

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 changes 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
 Significant 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, contact your doctor:

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

This is not an exhaustive list of possible side effects. 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:

  • Shortness of breath or difficulty breathing
  • Swelling in your hands, ankles, or feet
  • Sudden weight gain
  • Headache, confusion, or unusual drowsiness
  • Nausea or vomiting
  • Muscle cramps or weakness
  • Increased thirst or dry mouth
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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.
 All medications you are currently taking, including prescription and over-the-counter (OTC) drugs, natural products, and vitamins. This is crucial to avoid potential interactions between this medication and other substances.
* Any existing health problems, as this medication may interact with certain conditions.

To ensure your safety, it is vital to verify that it is safe to take this medication with all your current medications and health conditions. Never start, stop, or adjust the dose 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, to monitor your health. Be sure to follow your doctor's instructions and discuss any concerns or questions you may have.

When administering this medication to newborns, exercise caution, as the risk of side effects may be increased in this age group.

If you are pregnant, planning to become pregnant, or are breastfeeding, inform 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, heart failure)
  • Hypernatremia (e.g., thirst, dry mucous membranes, restlessness, irritability, disorientation, seizures, coma)
  • Hyperchloremia (e.g., metabolic acidosis, tachypnea, weakness, lethargy)
  • Hyponatremia (paradoxical, if rapid infusion in certain conditions or if ADH is high, leading to water retention and dilution)

What to Do:

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

Drug Interactions

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Moderate Interactions

  • Corticosteroids (e.g., Prednisone, Dexamethasone): May increase sodium and fluid retention, leading to edema and hypertension.
  • Drugs causing sodium retention (e.g., NSAIDs): May exacerbate fluid overload.
  • Diuretics (e.g., Furosemide, Hydrochlorothiazide): May alter electrolyte balance, requiring careful monitoring of sodium and chloride levels.
  • Lithium: Sodium intake can affect lithium excretion; changes in sodium levels may alter lithium concentrations.

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 (Vital Signs, Edema, Lung Sounds)

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

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 rapid infusion or in patients with impaired renal/cardiac function.

Target: Na+: 135-145 mEq/L; Cl-: 98-106 mEq/L

Action Threshold: Sodium <130 mEq/L or >150 mEq/L; Chloride <90 mEq/L or >115 mEq/L. Requires immediate clinical evaluation and adjustment of therapy.

Fluid Balance (Intake/Output)

Frequency: Every 4-8 hours, or continuously.

Target: Balanced or slightly positive/negative as per clinical goal.

Action Threshold: Significant positive or negative balance outside of clinical goals, indicating fluid overload or dehydration.

Vital Signs (BP, HR, RR)

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

Target: Within patient's normal range.

Action Threshold: Significant changes (e.g., hypertension, tachycardia, tachypnea) indicating fluid overload or other complications.

Physical Assessment (Edema, Lung Sounds, Skin Turgor)

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

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

Action Threshold: New or worsening peripheral/pulmonary edema, crackles in lungs, signs of dehydration.

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Symptom Monitoring

  • Signs of fluid overload (e.g., dyspnea, orthopnea, peripheral edema, weight gain, crackles in lungs, elevated blood pressure)
  • Signs of hyponatremia (e.g., headache, nausea, vomiting, lethargy, confusion, seizures, muscle cramps, weakness)
  • Signs of hypernatremia (e.g., thirst, dry mucous membranes, restlessness, irritability, disorientation, seizures, coma)
  • Signs of hyperchloremia (e.g., metabolic acidosis, tachypnea, weakness, lethargy)

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 for 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 with fluid retention.
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Lactation

Sodium chloride is a natural component of breast milk and the human body. Administration of 0.45% Sodium Chloride Injection is generally considered safe during lactation and is not expected to harm the breastfed infant.

Infant Risk: Low risk
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Pediatric Use

Pediatric patients, especially neonates and infants, have a higher proportion of total body water and immature renal function, making them more susceptible to fluid and electrolyte imbalances (e.g., hyponatremia, hypernatremia, fluid overload). Dosing must be precisely calculated based on weight and clinical status, and frequent monitoring of serum electrolytes and fluid balance is critical.

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Geriatric Use

Geriatric patients may have age-related decreases in renal function, cardiac reserve, and altered fluid regulation, increasing their susceptibility to fluid overload, electrolyte imbalances (e.g., hyponatremia), and adverse reactions. Use with caution, initiate at lower rates, and monitor fluid status and electrolytes closely.

Clinical Information

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Clinical Pearls

  • 0.45% Sodium Chloride (half-normal saline) is a hypotonic solution, meaning it has a lower concentration of solutes than blood. This causes fluid to shift from the intravascular space into the intracellular and interstitial spaces, making it useful for cellular rehydration.
  • It is commonly used for maintenance fluid therapy, especially when free water is needed, or in conditions like hypernatremia where a hypotonic solution is desired to lower serum sodium.
  • Risk of hyponatremia: Due to its hypotonicity, rapid or excessive administration can lead to hyponatremia, especially in patients with impaired water excretion (e.g., SIADH, renal impairment, heart failure) or in pediatric patients.
  • Not suitable for rapid volume expansion or resuscitation, as a significant portion of the fluid shifts out of the intravascular space.
  • Always monitor serum electrolytes (especially sodium) and fluid balance closely to prevent complications like hyponatremia, hypernatremia, or fluid overload.
  • Avoid in patients with conditions where additional free water is contraindicated or dangerous (e.g., cerebral edema, severe hyponatremia).
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Alternative Therapies

  • 0.9% Sodium Chloride (Normal Saline): Isotonic, used for volume expansion, resuscitation, and general fluid replacement.
  • Lactated Ringer's Solution (LR): Isotonic, contains electrolytes and lactate (metabolized to bicarbonate), used for volume expansion and electrolyte replacement.
  • 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 calories and electrolytes.
  • Dextrose 5% in 0.45% Sodium Chloride (D5 1/2 NS): Hypotonic, provides calories and electrolytes, commonly used for maintenance fluids.
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Cost & Coverage

Average Cost: $5 - $20 per 500ml bag
Generic Available: Yes
Insurance Coverage: Tier 1 (usually covered by most insurance plans as a basic medical supply)
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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 to 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 otherwise, do not flush medications down the toilet or pour them down the drain. If you are unsure about the best disposal method, consult your pharmacist, as they can provide guidance on available 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 it occurred, as this will aid in receiving appropriate treatment.