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Sod Chloride 0.9% W/ 20meq Kcl

Manufacturer BAXTER Active Ingredient Intravenous (IV) Fluids(in truh VEE nuhs FLOO ids) Pronunciation SO-dee-um KLOR-ide point nine per-SENT with TWEN-tee mil-ee-EK 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
Isotonic 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 an intravenous (IV) fluid, meaning it's given directly into your vein. It's a mixture of salt water (sodium chloride) and potassium. It's used to replace fluids and important salts in your body that you might have lost due to dehydration, illness, or surgery. It helps keep your body's fluid and salt levels balanced.
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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 discomfort or pain at the IV site immediately.
  • Inform your healthcare provider if you experience swelling, shortness of breath, or changes in your heart rate during or after the infusion.
  • Follow all instructions regarding fluid intake and diet as advised by your doctor.
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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 ongoing losses. Typically administered at rates from 50 mL/hour to 200 mL/hour or more, depending on hydration needs and electrolyte repletion.
Dose Range: 50 - 500 mg

Condition-Specific Dosing:

dehydration: Rate adjusted to correct fluid deficit, typically 100-250 mL/hr.
maintenance: Typically 50-125 mL/hr for maintenance fluid and electrolyte needs.
hypokalemia: Rate and duration adjusted based on severity of hypokalemia and patient's cardiac status, often not exceeding 10 mEq/hr in peripheral veins or 20 mEq/hr in central veins (for potassium component).
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Pediatric Dosing

Neonatal: Dosing highly individualized based on weight, gestational age, and clinical condition. Typically 60-100 mL/kg/day, adjusted for specific fluid and electrolyte deficits. Potassium administration requires extreme caution.
Infant: Dosing highly individualized based on weight and clinical condition. Typically 100-150 mL/kg/day, adjusted for specific fluid and electrolyte deficits. Potassium administration requires careful monitoring.
Child: Dosing highly individualized based on weight and clinical condition. Typically 80-120 mL/kg/day, adjusted for specific fluid and electrolyte deficits. Potassium administration requires careful monitoring.
Adolescent: Dosing individualized based on weight and clinical condition, often approaching adult doses. Typically 50-100 mL/kg/day, adjusted for specific fluid and electrolyte deficits.
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Dose Adjustments

Renal Impairment:

Mild: Use with caution; monitor fluid balance and electrolytes (especially potassium and sodium).
Moderate: Use with caution; monitor fluid balance and electrolytes closely. Reduced infusion rates may be necessary to prevent fluid overload and hyperkalemia.
Severe: Contraindicated or use with extreme caution; significant risk of fluid overload, hypernatremia, and life-threatening hyperkalemia. Close monitoring and potentially lower potassium concentrations or potassium-free solutions are required.
Dialysis: Contraindicated or use with extreme caution; fluid and electrolyte management is highly specific to dialysis regimen. Consult nephrologist. Potassium-containing solutions are generally avoided unless specifically indicated and closely monitored.

Hepatic Impairment:

Mild: Adjustment not typically required, but monitor for fluid retention (e.g., ascites, edema) and electrolyte imbalances.
Moderate: Monitor fluid balance closely; patients with significant liver disease may have impaired fluid and electrolyte regulation. Adjust rate to prevent fluid overload.
Severe: Monitor fluid balance and electrolytes closely; patients with severe liver disease (e.g., cirrhosis with ascites) are prone to fluid retention and electrolyte disturbances. Adjust rate to prevent fluid overload and hyponatremia.

Pharmacology

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Mechanism of Action

Sodium Chloride 0.9% provides water and electrolytes (sodium and chloride) to maintain osmotic pressure and expand the extracellular fluid compartment. Potassium Chloride 20 mEq provides potassium, an essential intracellular cation, crucial for nerve impulse transmission, muscle contraction (including cardiac muscle), and maintenance of intracellular tonicity, as well as normal renal function and acid-base balance. The solution helps restore fluid volume, correct electrolyte deficits, and maintain hydration.
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Pharmacokinetics

Absorption:

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

Distribution:

Vd: Approximately 0.2 L/kg (extracellular fluid volume for sodium and chloride); Potassium distributes throughout total body water, with 98% intracellular.
ProteinBinding: Not protein bound (ions)
CnssPenetration: Limited (ions do not readily cross intact blood-brain barrier, but changes in serum osmolality can affect CNS fluid shifts)

Elimination:

HalfLife: Variable (depends on fluid and electrolyte balance, renal function, and ongoing losses)
Clearance: Primarily renal excretion; also via sweat, GI tract.
ExcretionRoute: Renal (urine)
Unchanged: 100% (ions are excreted as ions)
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Pharmacodynamics

OnsetOfAction: Immediate (upon initiation of infusion)
PeakEffect: Achieved during infusion, maintained as long as infusion continues and homeostatic mechanisms are intact.
DurationOfAction: Variable (depends on infusion rate, patient's fluid and electrolyte status, and renal function; typically short-lived once infusion stops as excess is excreted or distributed)

Safety & Warnings

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Side Effects

Serious Side Effects: Seek Medical Attention 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 help 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, such as:
+ 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. 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 or seek medical help:

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

This is not a comprehensive list of all possible 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:

  • Swelling in your hands, feet, or ankles (edema)
  • Difficulty breathing or shortness of breath
  • Chest pain or irregular heartbeat
  • Muscle weakness or numbness/tingling
  • Confusion or unusual drowsiness
  • Severe thirst or dry mouth
  • Dizziness or lightheadedness
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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 information will help your doctor and pharmacist assess potential interactions between this medication and other substances you are taking.
* Any existing health problems, as this medication may interact with certain conditions.

To ensure your safety, it is crucial to verify that it is safe to take this medication with all your current medications and health conditions. Never start, stop, or change 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 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 a newborn, exercise caution. Newborns may have a higher risk of experiencing side effects.

If you are pregnant, planning to become pregnant, or are breastfeeding, inform your doctor. It is necessary to discuss the potential 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 (e.g., pulmonary edema, peripheral edema, hypertension)
  • Hyperkalemia (e.g., muscle weakness, paresthesias, bradycardia, cardiac arrest)
  • Hypernatremia (e.g., thirst, lethargy, confusion, seizures, coma)
  • Metabolic acidosis (due to chloride load)

What to Do:

Immediate discontinuation of infusion. Management is supportive and depends on the specific electrolyte imbalance and severity. May include diuretics for fluid overload, calcium gluconate, insulin/glucose, sodium bicarbonate, or dialysis for severe hyperkalemia. Call 911 or Poison Control (1-800-222-1222) immediately.

Drug Interactions

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Contraindicated Interactions

  • Patients with known hypersensitivity to any component.
  • Patients with hypernatremia.
  • Patients with hyperkalemia.
  • Patients with severe renal impairment (anuria, oliguria) unless closely monitored and managed.
  • Patients with uncompensated heart failure or severe fluid retention.
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Major Interactions

  • ACE inhibitors/ARBs/Potassium-sparing diuretics: Increased risk of hyperkalemia due to reduced potassium excretion.
  • Digoxin: Hyperkalemia can antagonize the effects of digoxin; hypokalemia can potentiate digoxin toxicity. Careful monitoring of potassium levels is crucial.
  • Corticosteroids/ACTH: May cause sodium and fluid retention, increasing risk of fluid overload and hypertension.
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Moderate Interactions

  • Loop diuretics/Thiazide diuretics: May alter sodium and potassium balance; monitor electrolytes closely.
  • Insulin: Can shift potassium intracellularly, potentially causing transient hypokalemia, which may require adjustment of potassium infusion rate.
  • Cyclosporine/Tacrolimus: May increase risk of hyperkalemia.
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Minor Interactions

  • Lithium: Sodium intake can affect lithium excretion; monitor lithium levels.

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, especially potassium.

Timing: Prior to initiation of therapy

Fluid Status (Vital signs, I&O, weight, edema)

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

Timing: Prior to initiation of therapy

Cardiac Status (ECG)

Rationale: Especially important if potassium levels are significantly abnormal or patient has cardiac history, as hyperkalemia can cause life-threatening arrhythmias.

Timing: Prior to initiation of therapy, if indicated

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Routine Monitoring

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

Frequency: Every 4-24 hours, depending on clinical status and infusion rate; more frequently in critical care or with rapid changes.

Target: Sodium: 135-145 mEq/L; Potassium: 3.5-5.0 mEq/L; Chloride: 98-107 mEq/L

Action Threshold: Values outside normal range, especially K+ > 5.5 mEq/L or < 3.0 mEq/L, or Na+ < 130 mEq/L or > 150 mEq/L; requires immediate assessment and intervention.

Fluid Balance (Intake and Output, Daily Weight)

Frequency: Every 4-8 hours (I&O); Daily (weight)

Target: Balanced I&O, stable weight (or appropriate change based on clinical goals)

Action Threshold: Significant positive or negative fluid balance, rapid weight gain (>1 kg/day) or loss, signs of fluid overload or dehydration.

Vital Signs (BP, HR, RR)

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

Target: Within patient's normal limits

Action Threshold: Significant changes indicating fluid overload (e.g., elevated BP, crackles) or dehydration (e.g., orthostatic hypotension, tachycardia).

Renal Function (BUN, Creatinine)

Frequency: Daily to every few days, depending on clinical stability.

Target: Within normal limits or stable for patient's baseline.

Action Threshold: Significant increase in BUN/Creatinine, indicating worsening renal function.

ECG Monitoring

Frequency: Continuous or frequent, if hyperkalemia is a concern or patient has cardiac risk factors.

Target: Normal cardiac rhythm and intervals.

Action Threshold: Peaked T waves, prolonged PR interval, widened QRS, loss of P wave, or other arrhythmias indicative of hyperkalemia.

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Symptom Monitoring

  • Signs of fluid overload (e.g., peripheral edema, pulmonary crackles, dyspnea, jugular venous distension, hypertension)
  • Signs of hyperkalemia (e.g., muscle weakness, paresthesias, fatigue, bradycardia, cardiac arrhythmias, abdominal cramps, diarrhea)
  • Signs of hypernatremia (e.g., thirst, dry mucous membranes, confusion, lethargy, seizures, coma)
  • Signs of hypokalemia (if potassium is being depleted faster than replaced, e.g., muscle weakness, cramps, constipation, arrhythmias)
  • Signs of infusion site reactions (e.g., pain, redness, swelling, phlebitis)

Special Patient Groups

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Pregnancy

Generally considered safe and often necessary for fluid and electrolyte management during pregnancy. However, fluid and electrolyte status should be carefully monitored to avoid imbalances that could affect the mother or fetus.

Trimester-Specific Risks:

First Trimester: No known specific risks beyond general fluid/electrolyte balance.
Second Trimester: No known specific risks beyond general fluid/electrolyte balance.
Third Trimester: No known specific risks beyond general fluid/electrolyte balance; careful monitoring for fluid overload is important, especially in pre-eclampsia.
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Lactation

Considered safe for use during lactation. Sodium and potassium are normal components of breast milk, and administration of this solution is unlikely to cause adverse effects in the nursing infant.

Infant Risk: Low risk
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Pediatric Use

Use with extreme caution. Pediatric patients, especially neonates and infants, have immature renal function and are highly susceptible to fluid and electrolyte imbalances. Dosing must be precisely calculated based on weight, age, and clinical status. Close monitoring of serum electrolytes, fluid balance, and vital signs is critical to prevent hyperkalemia, hypernatremia, and fluid overload.

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Geriatric Use

Use with caution. Elderly patients may have age-related decline in renal function, pre-existing cardiac conditions, and altered fluid regulation, increasing their susceptibility to fluid overload, hypernatremia, and hyperkalemia. Lower infusion rates and closer monitoring of fluid status, electrolytes, and renal function are often necessary.

Clinical Information

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Clinical Pearls

  • Always verify the correct solution and concentration before administration, especially the potassium content, as errors can be fatal.
  • Administer potassium-containing solutions slowly; rapid infusion of potassium can cause fatal arrhythmias.
  • Never administer potassium chloride as a rapid IV push or bolus.
  • Ensure adequate urine output before administering potassium-containing solutions to prevent hyperkalemia.
  • Monitor IV site closely for signs of infiltration or phlebitis, especially with potassium, which can be irritating to veins.
  • This solution is isotonic and primarily expands the extracellular fluid volume. It is not suitable for correcting severe intracellular dehydration.
  • Consider patient's cardiac status and medications (e.g., ACE inhibitors, ARBs, potassium-sparing diuretics) that can affect potassium levels.
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Alternative Therapies

  • 0.9% Sodium Chloride (Normal Saline) - for fluid and sodium replacement without potassium.
  • Lactated Ringer's Solution - for fluid and electrolyte replacement with a more balanced electrolyte profile (including potassium, calcium, lactate).
  • Dextrose 5% in Water (D5W) - for free water replacement and calorie source, no electrolytes.
  • Oral rehydration solutions - for mild to moderate dehydration in conscious patients.
  • Potassium Chloride oral supplements - for potassium repletion in patients who can tolerate oral intake.
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Cost & Coverage

Average Cost: Typically low cost, varies by volume and supplier per 1000 mL bag
Generic Available: Yes
Insurance Coverage: Covered by most insurance plans as a medical supply/service when administered in a healthcare setting.
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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, 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.