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Sod Chloride 23.4% Inj, 200ml

Manufacturer FRESENIUS KABI 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 and fluid replacement, Osmotic agent
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Pharmacologic Class
Electrolyte, Crystalloid 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?

This medication is a very concentrated salt solution given directly into your vein. It is used in the hospital to quickly correct very low salt levels in your blood or to reduce swelling in the brain. It is not a routine fluid and is used only in specific, serious situations under close medical supervision.
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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 its color has changed.

To dispose of used needles and other sharp objects, use 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

  • This medication is administered in a hospital setting and is not for self-administration.
  • Follow all instructions from your healthcare team regarding fluid intake and diet during and after treatment.
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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 sodium deficit, clinical status, and rate of correction desired. For severe, symptomatic hyponatremia (e.g., seizures, coma), typical initial bolus is 100 mL of 3% NaCl (or equivalent 23.4% NaCl diluted) over 10-30 minutes. 23.4% NaCl is typically used as an additive or for very specific, controlled boluses.

Condition-Specific Dosing:

severe_symptomatic_hyponatremia: Initial bolus of 100 mL of 3% NaCl (equivalent to 12.8 mL of 23.4% NaCl) over 10-30 minutes, repeated once or twice if symptoms persist. Subsequent management involves slower infusions to achieve target sodium correction rate (e.g., 0.5-1 mEq/L/hour, not exceeding 8-12 mEq/L in 24 hours).
cerebral_edema: Specific protocols vary, often involves small, controlled boluses or continuous infusions to maintain serum osmolality.
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Pediatric Dosing

Neonatal: Not established for routine use; extreme caution and expert consultation required for severe hyponatremia. Dosing is weight-based and highly individualized.
Infant: Not established for routine use; extreme caution and expert consultation required for severe hyponatremia. Dosing is weight-based and highly individualized.
Child: For severe symptomatic hyponatremia: 2-4 mL/kg of 3% NaCl (equivalent to 0.25-0.5 mL/kg of 23.4% NaCl) over 10-30 minutes. Close monitoring is essential.
Adolescent: Similar to adult dosing for severe symptomatic hyponatremia, with careful consideration of weight and fluid status.
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Dose Adjustments

Renal Impairment:

Mild: Use with caution; monitor fluid and electrolyte status closely.
Moderate: Increased risk of fluid overload and electrolyte imbalance; use with extreme caution and frequent monitoring.
Severe: Contraindicated in anuric patients; use with extreme caution and frequent monitoring in other severe renal impairment. Dialysis may be required to manage fluid and electrolyte balance.
Dialysis: Considerations: May be used to correct hyponatremia in dialysis patients, but fluid overload is a significant risk. Close collaboration with nephrology is essential.

Hepatic Impairment:

Mild: Use with caution; monitor fluid and electrolyte status.
Moderate: Increased risk of fluid overload and electrolyte imbalance, especially in patients with ascites or cirrhosis; use with extreme caution.
Severe: Increased risk of fluid overload and electrolyte imbalance; use with extreme caution and frequent monitoring.

Pharmacology

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Mechanism of Action

Sodium Chloride 23.4% Injection is a hypertonic solution that increases serum sodium concentration and serum osmolality. This creates an osmotic gradient, drawing water from the intracellular space (including brain cells) into the extracellular fluid compartment, thereby reducing cellular swelling (e.g., cerebral edema) and correcting hyponatremia.
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Pharmacokinetics

Absorption:

Bioavailability: 100%
Tmax: Not applicable (IV administration, immediate effect)
FoodEffect: Not applicable

Distribution:

Vd: Approximately 0.2 L/kg (extracellular fluid volume)
ProteinBinding: Not applicable
CnssPenetration: Limited (does not readily cross intact blood-brain barrier, but osmotic effect influences brain water content)

Elimination:

HalfLife: Not applicable (elimination depends on renal function and fluid balance)
Clearance: Primarily renal clearance of sodium and chloride ions
ExcretionRoute: Renal (urine)
Unchanged: 100%
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Pharmacodynamics

OnsetOfAction: Rapid (minutes)
PeakEffect: Rapid (within minutes to hours, depending on dose and patient response)
DurationOfAction: Variable, depends on renal function, ongoing fluid shifts, and underlying cause of hyponatremia. Effects on serum sodium can last for several 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 immediately or seek emergency 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
+ Difficulty urinating or changes in urine output
+ 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. While many people may not experience any side effects or only minor 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 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:

  • This medication is given in a controlled environment, so patients are not typically monitoring for self-reported warning symptoms related to administration. However, healthcare providers will monitor for signs of:
  • Fluid overload (e.g., difficulty breathing, swelling in legs/ankles)
  • Signs of too much salt (e.g., extreme thirst, confusion, weakness)
  • New or worsening neurological symptoms (e.g., speech difficulties, trouble swallowing, weakness, changes in consciousness) which could indicate a serious complication called Osmotic Demyelination Syndrome (ODS).
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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 identify 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 crucial to verify that it is safe to take this medication with all your current medications and health conditions. Always consult your doctor before starting, stopping, or changing the dose of any medication.
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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.

If your medication contains dextrose and you have diabetes (high blood sugar), discuss this with your doctor to ensure safe use.

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, 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:

  • Hypernatremia (excessively high sodium levels)
  • Fluid overload (pulmonary edema, peripheral edema, congestive heart failure)
  • Cerebral dehydration and hemorrhage
  • Osmotic Demyelination Syndrome (ODS) - delayed onset, severe neurological deficits
  • Metabolic acidosis (due to high chloride load)

What to Do:

Immediate discontinuation of infusion. Management is supportive and may include administration of hypotonic fluids (e.g., D5W) to lower sodium, diuretics to manage fluid overload, and close monitoring of electrolytes and neurological status. Call 1-800-222-1222 (Poison Control) for further guidance.

Drug Interactions

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Contraindicated Interactions

  • Hypernatremia
  • Severe fluid overload (e.g., acute pulmonary edema, severe congestive heart failure) where additional sodium and fluid would be detrimental
  • Anuria (unless used in specific dialysis protocols)
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Major Interactions

  • Corticosteroids (e.g., prednisone, hydrocortisone): May cause sodium and fluid retention, increasing risk of hypernatremia and fluid overload.
  • Drugs causing sodium retention (e.g., NSAIDs): May exacerbate hypernatremia or fluid overload.
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Moderate Interactions

  • Lithium: Sodium levels can affect lithium excretion. Changes in sodium concentration can alter lithium levels, potentially leading to toxicity or subtherapeutic effects.
  • Diuretics (e.g., loop diuretics, thiazide diuretics): Can alter fluid and electrolyte balance, requiring careful monitoring when co-administered with hypertonic saline.
  • Vasopressin receptor antagonists (e.g., tolvaptan): Used to treat hyponatremia; co-administration with hypertonic saline requires very careful monitoring to avoid overly rapid sodium correction.
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Minor Interactions

  • Not many specific minor interactions; general caution with any medication affecting fluid/electrolyte balance.

Monitoring

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Baseline Monitoring

Serum Electrolytes (Sodium, Potassium, Chloride)

Rationale: To establish baseline sodium level and assess for other electrolyte imbalances.

Timing: Prior to initiation of therapy

Renal Function (BUN, Creatinine)

Rationale: To assess kidney function, which impacts sodium excretion and fluid balance.

Timing: Prior to initiation of therapy

Fluid Status (Vital Signs, Physical Exam for Edema, Lung Sounds)

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

Timing: Prior to initiation of therapy

Neurological Status (GCS, mental status)

Rationale: To assess baseline neurological function, especially in symptomatic hyponatremia.

Timing: Prior to initiation of therapy

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Routine Monitoring

Serum Sodium

Frequency: Every 1-2 hours initially during rapid correction, then every 4-6 hours once stable or during slower correction.

Target: Correction rate of 0.5-1 mEq/L/hour, not exceeding 8-12 mEq/L in 24 hours (to prevent Osmotic Demyelination Syndrome).

Action Threshold: If sodium correction rate exceeds target, stop infusion and consider administering D5W or desmopressin. If sodium correction is too slow, adjust infusion rate.

Serum Potassium, Chloride, Glucose

Frequency: Every 4-6 hours or as clinically indicated.

Target: Within normal limits.

Action Threshold: Address any significant abnormalities.

Fluid Balance (Intake and Output)

Frequency: Every 1-4 hours, depending on clinical stability.

Target: Appropriate balance to avoid fluid overload or dehydration.

Action Threshold: Adjust fluid administration based on balance and clinical status.

Vital Signs (BP, HR, RR, Temp)

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

Target: Within patient's normal range.

Action Threshold: Address significant deviations.

Neurological Status

Frequency: Continuously or every 1-4 hours, depending on severity.

Target: Improvement in symptoms without signs of over-correction.

Action Threshold: Report any worsening symptoms or signs of Osmotic Demyelination Syndrome (e.g., new neurological deficits).

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Symptom Monitoring

  • Signs of fluid overload (e.g., dyspnea, crackles, peripheral edema, elevated JVP)
  • Signs of hypernatremia (e.g., thirst, lethargy, irritability, seizures, coma)
  • Signs of Osmotic Demyelination Syndrome (ODS) (e.g., dysarthria, dysphagia, quadriparesis, altered consciousness - typically delayed onset days after rapid correction)

Special Patient Groups

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Pregnancy

Category C. Use only if the potential benefit justifies the potential risk to the fetus. Careful monitoring of maternal fluid and electrolyte balance is crucial.

Trimester-Specific Risks:

First Trimester: Risk of electrolyte imbalance and fluid overload to the mother, which could indirectly affect fetal development.
Second Trimester: Risk of electrolyte imbalance and fluid overload to the mother, which could indirectly affect fetal development.
Third Trimester: Risk of electrolyte imbalance and fluid overload to the mother, which could indirectly affect fetal development, and potential for maternal pulmonary edema.
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Lactation

L3 (Moderately safe). Sodium and chloride are normal components of breast milk. However, high maternal doses or rapid changes in maternal sodium levels could potentially affect the infant. Use with caution and monitor infant for signs of electrolyte imbalance or fluid changes.

Infant Risk: Low risk with appropriate maternal monitoring and controlled administration. Potential for electrolyte imbalance in infant if maternal levels fluctuate significantly.
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Pediatric Use

Use with extreme caution. Pediatric patients, especially neonates and infants, are more susceptible to fluid and electrolyte imbalances and the risks of rapid sodium correction (e.g., ODS). Dosing must be precise and weight-based, with very frequent monitoring of serum sodium and neurological status. Expert consultation is highly recommended.

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Geriatric Use

Increased risk of fluid overload, congestive heart failure, and renal impairment. Geriatric patients may also be more susceptible to the neurological complications of hyponatremia and its correction. Use with caution, lower initial doses, and very close monitoring of fluid status, renal function, and electrolytes.

Clinical Information

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Clinical Pearls

  • Sodium Chloride 23.4% Injection is a highly concentrated hypertonic saline solution and should NEVER be administered undiluted as a rapid bolus unless specifically indicated for life-threatening, symptomatic hyponatremia (e.g., seizures, coma) and under strict medical supervision.
  • The primary risk of rapid correction of chronic hyponatremia is Osmotic Demyelination Syndrome (ODS), a severe and often irreversible neurological disorder. The rate of sodium correction should generally not exceed 8-12 mEq/L in 24 hours.
  • This solution is often diluted to 3% or 7.5% NaCl for infusion, or used as a small volume additive. If administered directly, it should be via a central venous catheter due to its high osmolality and potential for peripheral vein irritation/sclerosis.
  • Frequent (e.g., hourly or every 2 hours) monitoring of serum sodium is paramount during the initial phase of correction.
  • Consider the underlying cause of hyponatremia (e.g., SIADH, hypovolemia, hypervolemia) as it dictates the overall management strategy beyond just sodium correction.
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Alternative Therapies

  • For hyponatremia: Fluid restriction (for euvolemic/hypervolemic hyponatremia), Normal Saline (0.9% NaCl) (for hypovolemic hyponatremia), Vasopressin receptor antagonists (e.g., tolvaptan, conivaptan) (for euvolemic/hypervolemic hyponatremia)
  • For cerebral edema: Mannitol, Hyperventilation (acute management), Dexamethasone (for vasogenic edema)
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Cost & Coverage

Average Cost: $10 - $50 per 200ml vial
Generic Available: Yes
Insurance Coverage: Tier 1 (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, 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 or pharmacist, 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, as community drug take-back programs may be available. Some medications may come with an additional patient information leaflet; check with your pharmacist for more information. 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 details about the medication taken, the amount, and the time of the incident.