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Sod Chloride 0.9% Inj, 1000ml

Manufacturer GRIFOLS 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
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Pharmacologic Class
Crystalloid Solution; Isotonic Solution
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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?

Sodium Chloride 0.9% Injection, also known as normal saline, is a sterile salt water solution given through a vein (intravenously). It's used to replace fluids and salts that your body might be missing, for example, due to dehydration, blood loss, or during surgery. It helps keep your body's fluid balance normal.
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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 solution if it 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

  • Report any swelling in your hands, feet, or ankles.
  • Report any difficulty breathing or shortness of breath.
  • Report any unusual thirst or changes in urination.
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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, clinical condition, and response to therapy. Typical maintenance: 1-3 L/24 hours. Resuscitation: 500-1000 mL bolus, repeated as needed.
Dose Range: 500 - 3000 mg

Condition-Specific Dosing:

dehydration: 500-1000 mL/hour initially, then adjusted based on hydration status and urine output.
hypovolemic_shock: Rapid infusion of 1000-2000 mL, then adjusted based on hemodynamic response.
maintenance_fluid: Typically 1-1.5 mL/kg/hour, adjusted for clinical needs.
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Pediatric Dosing

Neonatal: Maintenance: 60-100 mL/kg/day. Resuscitation: 10-20 mL/kg bolus over 5-10 minutes, repeated as needed.
Infant: Maintenance: 100-150 mL/kg/day. Resuscitation: 10-20 mL/kg bolus over 5-10 minutes, repeated as needed.
Child: Maintenance: 80-120 mL/kg/day. Resuscitation: 10-20 mL/kg bolus over 5-10 minutes, repeated as needed.
Adolescent: Maintenance: 60-100 mL/kg/day or adult dosing. Resuscitation: 10-20 mL/kg bolus over 5-10 minutes, repeated as needed.
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Dose Adjustments

Renal Impairment:

Mild: Use with caution; monitor fluid balance and electrolytes.
Moderate: Use with caution; monitor fluid balance and electrolytes closely to avoid fluid overload and hypernatremia/hyperchloremia.
Severe: Use with extreme caution; often contraindicated or used in very small volumes due to risk of fluid overload, hypernatremia, and hyperchloremia. Consider alternative fluids or dialysis.
Dialysis: Fluid and electrolyte management should be guided by dialysis schedule and patient's interdialytic weight gain and electrolyte levels. Often used to replace fluid removed during dialysis or for specific indications.

Hepatic Impairment:

Mild: No specific adjustment needed, but monitor for fluid retention if ascites or edema are present.
Moderate: No specific adjustment needed, but monitor for fluid retention and electrolyte imbalances, especially in patients with ascites or portal hypertension.
Severe: No specific adjustment needed, but monitor closely for fluid retention, ascites, and electrolyte disturbances. May exacerbate fluid overload in patients with decompensated cirrhosis.

Pharmacology

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Mechanism of Action

Sodium Chloride 0.9% Injection is an isotonic solution that provides water and electrolytes (sodium and chloride) for hydration. It expands the extracellular fluid compartment, including the intravascular and interstitial spaces, without causing significant fluid shifts into or out of cells. Sodium is the primary cation of the extracellular fluid and plays a major role in fluid and electrolyte balance, nerve function, and muscle contraction. Chloride is the major extracellular anion and is involved in maintaining acid-base balance.
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Pharmacokinetics

Absorption:

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

Distribution:

Vd: Approximately 0.2 L/kg (extracellular fluid volume)
ProteinBinding: Not applicable (ions)
CnssPenetration: Yes (distributes throughout total body water, including CSF)

Elimination:

HalfLife: Variable (depends on fluid balance and renal function)
Clearance: Renal clearance of excess water and electrolytes
ExcretionRoute: Renal (urine)
Unchanged: 100% (ions are excreted as such)
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Pharmacodynamics

OnsetOfAction: Immediate
PeakEffect: Within minutes of infusion completion
DurationOfAction: Variable, depends on patient's fluid status, renal function, and ongoing losses; typically hours.

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 extremely 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 may not experience any side effects or may only have mild ones. If you notice 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

This is not an exhaustive list of possible side effects. If you have questions or concerns, 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 (edema) in legs, ankles, feet, or hands.
  • Shortness of breath or difficulty breathing.
  • Rapid weight gain.
  • Headache, dizziness, or confusion.
  • Muscle weakness or cramps.
  • 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.
 Potential interactions with other medications or health conditions. This drug may interact with other prescription or over-the-counter (OTC) medications, natural products, or vitamins, which could affect its safety and efficacy.
A complete list of all your current medications, including prescription and OTC drugs, natural products, and vitamins. This information will help your doctor and pharmacist assess potential interactions and ensure safe use.
 Any existing health problems, as they may impact the safety and effectiveness of this medication.

To ensure your safety, do not start, stop, or change the dose of any medication without first consulting your doctor. It is crucial to verify that it is safe to take this medication with all your other medications and health conditions.
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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 use.

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

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 (hypervolemia): peripheral and pulmonary edema, hypertension, tachycardia, dyspnea, jugular venous distention.
  • Hypernatremia: thirst, lethargy, irritability, seizures, coma.
  • Hyperchloremia: metabolic acidosis, weakness, lethargy.
  • Electrolyte disturbances.

What to Do:

Discontinue infusion immediately. Administer diuretics to promote fluid excretion. Correct electrolyte imbalances. Provide supportive care. In severe cases, dialysis may be required. Call 1-800-222-1222 (Poison Control) for advice, or seek immediate medical attention.

Drug Interactions

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Major Interactions

  • Corticosteroids (e.g., Prednisone, Hydrocortisone): May increase risk of sodium retention and edema.
  • Lithium: Large volumes of sodium chloride can increase renal excretion of lithium, potentially decreasing lithium levels and efficacy.
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Moderate Interactions

  • Diuretics (e.g., Furosemide, Hydrochlorothiazide): May alter fluid and electrolyte balance, requiring careful monitoring.
  • Drugs that cause sodium retention (e.g., NSAIDs): May increase risk of fluid overload.

Monitoring

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Baseline Monitoring

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

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

Timing: Prior to initiation of therapy.

Renal Function (BUN, Creatinine)

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

Timing: Prior to initiation of therapy.

Fluid Status (Weight, Vital Signs, Edema)

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

Timing: Prior to initiation of therapy.

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Routine Monitoring

Fluid Intake and Output (I&O)

Frequency: Every 4-8 hours or continuously, depending on clinical status.

Target: Positive or negative balance as clinically indicated.

Action Threshold: Significant positive balance (e.g., >1-2 L/24h) or negative balance (e.g., >1-2 L/24h) without clinical indication.

Vital Signs (BP, HR, RR)

Frequency: Every 1-4 hours, or as clinically indicated.

Target: Within patient's normal range.

Action Threshold: Significant changes (e.g., increasing BP, decreasing HR, increasing RR) suggesting fluid overload or persistent hypovolemia.

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

Frequency: Daily or more frequently if large volumes are administered or imbalances are suspected.

Target: Na: 135-145 mEq/L, Cl: 98-107 mEq/L.

Action Threshold: Na >145 mEq/L (hypernatremia) or <135 mEq/L (hyponatremia); Cl >107 mEq/L (hyperchloremia).

Body Weight

Frequency: Daily.

Target: Stable or desired change.

Action Threshold: Rapid weight gain (>1-2 kg/day) suggesting fluid retention.

Clinical Assessment (Edema, Lung Sounds, JVD)

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

Target: Absence of new or worsening signs of fluid overload.

Action Threshold: New onset or worsening peripheral edema, crackles/rales on lung auscultation, elevated JVD.

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Symptom Monitoring

  • Signs of fluid overload: peripheral edema, pulmonary edema (shortness of breath, crackles/rales), elevated blood pressure, distended neck veins, headache.
  • Signs of hypernatremia: thirst, lethargy, weakness, irritability, seizures, coma.
  • Signs of hyperchloremia: metabolic acidosis, weakness, lethargy.
  • Signs of electrolyte imbalance: muscle weakness, cramps, confusion, arrhythmias.

Special Patient Groups

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Pregnancy

Sodium chloride 0.9% is commonly used in pregnancy for fluid replacement and hydration. While generally considered safe, large volumes should be administered with caution to avoid fluid overload, especially in women with pre-eclampsia or cardiac conditions. Monitoring of fluid balance and electrolytes is important.

Trimester-Specific Risks:

First Trimester: Generally safe; no known specific risks.
Second Trimester: Generally safe; no known specific risks.
Third Trimester: Generally safe, but increased risk of fluid overload in women with pre-existing conditions like pre-eclampsia or cardiac disease. Monitor closely.
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Lactation

Sodium chloride 0.9% is considered safe for use during lactation. Sodium and chloride are natural components of breast milk, and administration of isotonic saline is not expected to significantly alter their concentrations in milk or pose a risk to the nursing infant.

Infant Risk: Low risk (L1)
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Pediatric Use

Use with caution, especially in neonates and infants, due to immature renal function and higher risk of fluid and electrolyte imbalances. Dosing should be carefully calculated based on weight and clinical need. Close monitoring of fluid balance, electrolytes, and vital signs is crucial to prevent fluid overload or dehydration.

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Geriatric Use

Use with caution due to age-related decline in renal function, decreased cardiac reserve, and increased susceptibility to fluid overload and electrolyte imbalances. Start with lower infusion rates and monitor fluid balance, electrolytes, and cardiovascular status closely. May be more prone to hypernatremia or hyperchloremia if renal function is impaired.

Clinical Information

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Clinical Pearls

  • 0.9% Sodium Chloride is an isotonic solution, meaning it has a similar osmolality to blood plasma. It primarily expands the extracellular fluid compartment.
  • It is the fluid of choice for initial resuscitation in hypovolemic shock due to its rapid expansion of intravascular volume.
  • Excessive administration can lead to hyperchloremic metabolic acidosis due to the relatively high chloride content compared to plasma.
  • Not suitable for free water deficits (e.g., severe hypernatremia) as it does not provide free water.
  • Always assess patient's fluid status, renal function, and electrolyte levels before and during administration.
  • Caution is advised in patients with heart failure, renal impairment, or conditions predisposing to sodium retention (e.g., cirrhosis, corticosteroid use) due to the risk of fluid overload.
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Alternative Therapies

  • Dextrose 5% in Water (D5W) - for free water deficit, not volume expansion
  • Dextrose 5% in 0.45% Sodium Chloride (D5 1/2 NS) - for maintenance fluids
  • Colloids (e.g., Albumin, Hetastarch) - for intravascular volume expansion, but with different properties and risks.
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Cost & Coverage

Average Cost: $2 - $10 per 1000ml bag
Generic Available: Yes
Insurance Coverage: Tier 1 (Preferred Generic) or covered as a medical supply/service in hospital/clinic settings.
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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 or take someone else's medication. 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; do not flush them down the toilet or pour them down the drain unless instructed to do so by a healthcare professional. 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 emergency medical attention. Be prepared to provide information about the medication taken, the amount, and the time of ingestion.