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Sod Chloride 0.9% Inj, 250ml

Manufacturer GRIFOLS USA 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
Electrolyte, Plasma Volume Expander, Isotonic Solution
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Pharmacologic Class
Isotonic Crystalloid Solution
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Pregnancy Category
Not available (considered safe and essential)
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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 common intravenous (IV) fluid. It's a sterile salt water solution that helps replace fluids and salts your body needs, especially if you are dehydrated, have lost blood, or need to receive other medications through an IV.
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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.

Safe Disposal of Needles and Sharps

After use, dispose of needles and other 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 immediately to determine the best course of action.
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Lifestyle & Tips

  • Report any swelling, difficulty breathing, or unusual weight gain to your healthcare provider immediately.
  • Inform your healthcare provider about all medications you are taking, including over-the-counter drugs and supplements.
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Available Forms & Alternatives

Available Strengths:

Dosing & Administration

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Adult Dosing

Standard Dose: Highly individualized based on clinical need (e.g., dehydration, shock, drug dilution). Typical infusion rates range from 75-150 mL/hour for maintenance to rapid boluses (e.g., 500-1000 mL over 15-60 minutes) for volume resuscitation.
Dose Range: 75 - 1000 mg

Condition-Specific Dosing:

maintenance: 75-150 mL/hour
volume_resuscitation: 500-1000 mL bolus over 15-60 minutes, repeated as needed
drug_dilution: Variable, typically 50-250 mL per dose of medication
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Pediatric Dosing

Neonatal: Highly individualized. Typically 10-20 mL/kg bolus for volume expansion, or 2-4 mL/kg/hour for maintenance, adjusted based on fluid status and electrolytes.
Infant: Highly individualized. Typically 10-20 mL/kg bolus for volume expansion, or 2-4 mL/kg/hour for maintenance, adjusted based on fluid status and electrolytes.
Child: Highly individualized. Typically 10-20 mL/kg bolus for volume expansion, or 2-4 mL/kg/hour for maintenance, adjusted based on fluid status and electrolytes.
Adolescent: Similar to adult dosing, 10-20 mL/kg bolus for volume expansion, or 75-150 mL/hour for maintenance, adjusted based on fluid status and electrolytes.
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Dose Adjustments

Renal Impairment:

Mild: Monitor fluid balance and electrolytes closely. Adjust rate as needed to avoid fluid overload.
Moderate: Monitor fluid balance and electrolytes closely. Adjust rate as needed to avoid fluid overload. May require lower rates.
Severe: Use with extreme caution. Close monitoring of fluid balance, electrolytes, and signs of fluid overload (e.g., pulmonary edema) is critical. May require significant reduction in rate or alternative fluids.
Dialysis: Administer only under strict medical supervision, typically to replace fluid removed during dialysis or for specific indications. Close monitoring of fluid balance and electrolytes is essential.

Hepatic Impairment:

Mild: No specific dose adjustment required, but monitor for fluid retention if ascites or edema is present.
Moderate: No specific dose adjustment required, but monitor for fluid retention if ascites or edema is present.
Severe: No specific dose adjustment required, but monitor for fluid retention, especially in patients with cirrhosis and ascites, due to increased risk of fluid overload and electrolyte disturbances.

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) to maintain the osmotic pressure of the extracellular fluid. It expands the extracellular fluid volume, including the interstitial and intravascular spaces. Sodium is the principal 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% (intravenous administration)
Tmax: Immediate (as it is directly infused into the bloodstream)
FoodEffect: Not applicable (IV administration)

Distribution:

Vd: Approximately 0.2 L/kg (extracellular fluid volume)
ProteinBinding: Not applicable (ions do not bind to plasma proteins in the traditional sense)
CnssPenetration: Limited (ions do not readily cross the blood-brain barrier, but changes in serum osmolality can affect CNS fluid shifts)

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 (urine)
Unchanged: 100% (ions are excreted as ions)
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Pharmacodynamics

OnsetOfAction: Immediate
PeakEffect: Immediate
DurationOfAction: Dependent on the patient's fluid and electrolyte status, renal function, and ongoing losses. Effects are transient as the body continuously regulates fluid and electrolytes.

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 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 have mild 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 ankles, feet, or hands
  • Shortness of breath or difficulty breathing
  • Sudden weight gain
  • Headache or confusion
  • Nausea or vomiting
  • Muscle cramps or weakness
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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 interact with other drugs or worsen certain health problems.
All medications you are currently taking, including:
+ Prescription medications
+ Over-the-counter (OTC) medications
+ Natural products
+ Vitamins
 Any existing health problems or conditions you have.

To ensure your safety, it is crucial to verify that this medication can be taken safely with all your other medications and health conditions. Never start, stop, or change 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 any salt substitutes or products that also contain potassium.

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 (hypervolemia)
  • Pulmonary edema (fluid in lungs)
  • Peripheral edema (swelling in extremities)
  • Hypernatremia (high sodium levels)
  • Hyperchloremia (high chloride levels)
  • Metabolic acidosis (due to high chloride)
  • Hypertension
  • Tachycardia
  • Congestive heart failure

What to Do:

Discontinue infusion immediately. Administer diuretics to promote fluid and electrolyte excretion. Provide supportive care. In severe cases of hypernatremia, careful administration of hypotonic fluids may be considered. Call 1-800-222-1222 (Poison Control) for further guidance if needed, though typically managed by medical professionals in a clinical setting.

Drug Interactions

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Moderate Interactions

  • Corticosteroids (e.g., prednisone, hydrocortisone): May increase sodium and fluid retention, leading to edema and hypertension.
  • Lithium: Sodium depletion can decrease lithium excretion, leading to increased lithium levels and toxicity. Conversely, high sodium intake can increase lithium excretion.
  • Diuretics (e.g., furosemide, hydrochlorothiazide): Can alter fluid and electrolyte balance, requiring careful monitoring when co-administered with saline solutions.

Monitoring

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Baseline Monitoring

Serum Electrolytes (Na+, Cl-)

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

Timing: Prior to initiation of therapy, especially in patients with renal or cardiac impairment.

Renal Function (BUN, Creatinine)

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

Timing: Prior to initiation, particularly in patients with known or suspected renal impairment.

Fluid Status (Weight, Edema, Lung Sounds)

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

Timing: Prior to initiation.

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Routine Monitoring

Fluid Balance (Intake/Output)

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/day) or signs of fluid overload.

Serum Electrolytes (Na+, Cl-)

Frequency: Daily or more frequently (e.g., every 4-6 hours) in critically ill patients or those receiving large volumes.

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

Action Threshold: Significant deviations (e.g., Na <130 or >150 mEq/L, Cl <90 or >115 mEq/L).

Vital Signs (BP, HR, RR)

Frequency: Every 1-4 hours, or as per institutional protocol.

Target: Within patient's normal range.

Action Threshold: Changes indicative of fluid overload (e.g., increasing BP, HR, RR) or hypovolemia (e.g., decreasing BP, increasing HR).

Physical Assessment (Edema, Lung Sounds, JVD)

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

Target: Absence of new or worsening edema, clear lung sounds, normal JVD.

Action Threshold: New onset or worsening peripheral/pulmonary edema, crackles in lungs, elevated JVD.

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Symptom Monitoring

  • Shortness of breath
  • Swelling (edema) in extremities or face
  • Weight gain
  • Headache
  • Nausea
  • Vomiting
  • Confusion
  • Muscle weakness or cramps (due to electrolyte imbalance)
  • Increased blood pressure
  • Rapid heart rate

Special Patient Groups

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Pregnancy

Sodium Chloride 0.9% Injection is considered safe and often essential during pregnancy for fluid and electrolyte replacement. It is frequently used for hydration, labor induction, and management of various pregnancy complications. Close monitoring of fluid balance is still important.

Trimester-Specific Risks:

First Trimester: Generally safe and used as needed.
Second Trimester: Generally safe and used as needed.
Third Trimester: Generally safe and used as needed. Monitor for fluid overload, especially in pre-eclamptic patients.
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Lactation

Sodium Chloride 0.9% Injection 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 cause adverse effects in the nursing infant.

Infant Risk: Low (L1 - Safest)
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Pediatric Use

Use with caution and careful monitoring of fluid balance and electrolytes. Pediatric patients, especially neonates and infants, have a higher proportion of total body water and less developed renal function, making them more susceptible to fluid overload and electrolyte imbalances (e.g., hyponatremia or hypernatremia). Dosing is typically weight-based (mL/kg).

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Geriatric Use

Use with caution. Elderly patients may have decreased renal function, cardiac reserve, and altered fluid regulation, increasing their susceptibility to fluid overload, hypernatremia, and other electrolyte disturbances. Close monitoring of fluid balance, electrolytes, and cardiovascular status is essential. Lower infusion rates may be necessary.

Clinical Information

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Clinical Pearls

  • Sodium Chloride 0.9% is an isotonic solution, meaning it has a similar osmolality to plasma. It primarily expands the extracellular fluid volume.
  • It is the fluid of choice for initial volume resuscitation in most cases of hypovolemic shock.
  • Often used as a diluent for intravenous medications.
  • Excessive administration can lead to hyperchloremic metabolic acidosis due to the relatively high chloride content compared to plasma.
  • Monitor for signs of fluid overload (e.g., pulmonary edema, peripheral edema, elevated JVP), especially in patients with cardiac or renal dysfunction.
  • Not suitable for free water deficits (e.g., severe hypernatremia) as it does not provide free water.
  • Consider alternative balanced salt solutions (e.g., Lactated Ringer's, Plasma-Lyte) in situations where large volumes of 0.9% NaCl might lead to hyperchloremic acidosis.
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Alternative Therapies

  • Lactated Ringer's Injection (LR)
  • Plasma-Lyte A Injection
  • Dextrose 5% in Water (D5W)
  • Dextrose 5% in 0.45% Sodium Chloride (D5 1/2 NS)
  • Colloids (e.g., Albumin, Hetastarch - though use of synthetic colloids is declining)
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Cost & Coverage

Average Cost: $1 - $10 per 250 mL bag
Generic Available: Yes
Insurance Coverage: Tier 1 (Preferred Generic)
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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. 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 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.