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Sodium Chloride 0.9% Inj, 10ml

Manufacturer HOSPIRA Active Ingredient Sodium Chloride Injection Solution(SOW dee um KLOR ide) Pronunciation SOW dee um KLOR ide
It is used to treat low sodium levels. It is used to treat fluid loss.It is used to mix with a drug that is given 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
Isotonic Crystalloid Solution
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Pregnancy 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 is a sterile salt water solution. It's commonly used in hospitals to give fluids to patients who are dehydrated, to help dilute other medications before they are given intravenously, or to flush IV lines.
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How to Use This Medicine

Taking Your Medication

To use this medication correctly, follow your doctor's instructions and read all the information provided. It is essential to follow the dosage instructions carefully. This medication is administered as an infusion into a vein over a specified period.

Storing and Disposing of Your Medication

If you need to store this medication at home, consult with your doctor, nurse, or pharmacist to determine the proper storage procedure.

Missing a Dose

If you miss a dose, contact your doctor immediately to receive guidance on what to do next.
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Lifestyle & Tips

  • Maintain adequate oral fluid intake if able, as advised by your doctor.
  • Report any swelling in your hands, feet, or ankles, or difficulty breathing, as these could be signs of too much fluid.
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Available Forms & Alternatives

Available Strengths:

Dosing & Administration

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Adult Dosing

Standard Dose: Highly variable based on indication (e.g., 500 mL to 3 L per 24 hours for maintenance or rehydration)

Condition-Specific Dosing:

diluent: Variable, typically 10 mL to 250 mL per dose for reconstitution or dilution of other medications
maintenance_fluid: Typically 1-3 L/day, adjusted to patient's fluid and electrolyte needs
volume_expansion: 500 mL to 1 L rapidly, repeated as needed based on clinical response
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Pediatric Dosing

Neonatal: Highly variable, typically 20 mL/kg bolus for volume expansion, or 60-100 mL/kg/day for maintenance, adjusted to clinical needs.
Infant: Highly variable, typically 20 mL/kg bolus for volume expansion, or 80-120 mL/kg/day for maintenance, adjusted to clinical needs.
Child: Highly variable, typically 20 mL/kg bolus for volume expansion, or 100-150 mL/kg/day for maintenance, adjusted to clinical needs.
Adolescent: Highly variable, typically 20 mL/kg bolus for volume expansion, or 100-150 mL/kg/day for maintenance, adjusted to clinical needs.
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Dose Adjustments

Renal Impairment:

Mild: Use with caution; monitor fluid and electrolyte balance.
Moderate: Use with caution; monitor fluid and electrolyte balance closely to avoid fluid overload and hypernatremia.
Severe: Use with extreme caution; significant risk of fluid overload, hypernatremia, and electrolyte imbalances. Dosing should be highly individualized and guided by strict monitoring.
Dialysis: Administer with extreme caution and under close supervision, as fluid and electrolyte balance are critical. Dosing should be individualized based on dialysis schedule and patient's fluid status.

Hepatic Impairment:

Mild: Use with caution; monitor for fluid retention.
Moderate: Use with caution; monitor for fluid retention and electrolyte imbalances, especially in patients with ascites or edema.
Severe: Use with extreme caution; significant risk of fluid overload and electrolyte disturbances, particularly in patients with cirrhosis and portal hypertension.

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 ions) to maintain osmotic pressure and fluid balance in the extracellular fluid compartment. It expands the intravascular and interstitial fluid volumes.
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Pharmacokinetics

Absorption:

Bioavailability: 100%
Tmax: Immediate
FoodEffect: Not applicable

Distribution:

Vd: Approximately 0.2 L/kg (extracellular fluid volume)
ProteinBinding: Not applicable (ions)
CnssPenetration: Yes (freely crosses blood-brain barrier)

Elimination:

HalfLife: Not applicable (homeostatically regulated)
Clearance: Primarily renal excretion, regulated by kidneys to maintain fluid and electrolyte balance.
ExcretionRoute: Renal
Unchanged: 100% (as ions)
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Pharmacodynamics

OnsetOfAction: Immediate
PeakEffect: Immediate
DurationOfAction: Dependent on patient's fluid balance, renal function, and ongoing fluid losses/intake; typically short-lived as fluid is distributed and excreted.

Safety & Warnings

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Side Effects

Serious Side Effects: Seek Medical Attention Immediately

Although rare, this medication can cause severe and potentially life-threatening side effects. If you experience 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 electrolyte problems, including:
+ Mood changes
+ Confusion
+ Muscle pain, cramps, or spasms
+ Weakness
+ Shakiness
+ Change in balance
+ Abnormal heartbeat
+ Seizures
+ Loss of appetite
+ Severe upset stomach or vomiting
Shortness of breath
 Sudden weight gain or swelling in the arms or legs
Severe dizziness or fainting
 Fever or chills
Shakiness
 Chest pain or pressure, or a rapid heartbeat
Flushing
 Burning, stinging, or redness at the injection site
* Pain and irritation at the injection site

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 contact your doctor if you have any symptoms that bother you or do not go away. Not all possible side effects are listed here. If you have questions or concerns about side effects, consult your doctor.

Reporting Side Effects

If you experience any side effects, you can report them to the FDA at 1-800-332-1088 or online at https://www.fda.gov/medwatch. Your doctor can also provide guidance on managing side effects and offer medical advice.
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Seek Immediate Medical Attention If You Experience:

  • Swelling (edema) in the face, hands, ankles, or feet.
  • Shortness of breath or difficulty breathing.
  • Unusual weight gain.
  • Increased thirst or dry mouth (signs of hypernatremia if fluid balance is off).
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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.
 If you have elevated sodium levels or swelling, as these conditions may be relevant to your treatment.

This list is not exhaustive, and it is crucial to discuss all your medications, including prescription and over-the-counter drugs, natural products, and vitamins, with your doctor and pharmacist. They will help you determine if it is safe to take this medication in combination with your other medications and health conditions.

Remember, do not start, stop, or adjust the dosage of any medication without first consulting your doctor to ensure your safety.
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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 you are following a low-salt or salt-free diet, consult with your doctor to discuss any potential interactions. Regular blood tests will be necessary, as directed by your doctor, to monitor your condition.

This medication may contain aluminum, which can increase the risk of aluminum toxicity with long-term use. This risk is particularly higher if you have pre-existing kidney problems or if you are a premature infant. It is crucial to discuss this potential risk with your doctor.

If you are pregnant, planning to become pregnant, or are breastfeeding, notify your doctor. You and your doctor will need to weigh the 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 (hypervolemia): peripheral and pulmonary edema, hypertension, tachycardia, dyspnea, jugular venous distension.
  • Hypernatremia: thirst, lethargy, weakness, irritability, seizures, coma, fever, flushed skin, dry mucous membranes.

What to Do:

Immediate medical attention is required. Treatment involves discontinuing the infusion, administering diuretics to promote fluid and sodium excretion, and providing supportive care. In severe cases of hypernatremia, careful administration of hypotonic fluids may be necessary. Call 1-800-222-1222 (Poison Control).

Drug Interactions

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Major Interactions

  • Corticosteroids (e.g., Prednisone, Dexamethasone): May enhance sodium and fluid retention, increasing risk of edema and hypertension.
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Moderate Interactions

  • Lithium: High sodium intake can increase renal excretion of lithium, potentially decreasing its therapeutic effect. Low sodium intake can decrease lithium excretion, leading to toxicity.
  • Drugs causing sodium retention (e.g., NSAIDs, some antihypertensives): May exacerbate fluid overload when co-administered with large volumes of sodium chloride.

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, especially with large volumes or in patients with renal/cardiac impairment.

Renal Function (BUN, Creatinine)

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

Timing: Prior to initiation, particularly in patients with 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 Intake and Output (I&O)

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

Target: Balanced I&O or as clinically indicated.

Action Threshold: Significant positive or negative fluid balance; notify provider.

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

Frequency: Daily or more frequently (e.g., every 6-12 hours) in critically ill patients or those receiving large volumes.

Target: Na: 135-145 mEq/L, K: 3.5-5.0 mEq/L, Cl: 98-107 mEq/L.

Action Threshold: Values outside normal range or rapid changes; notify provider.

Vital Signs (BP, HR, RR)

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

Target: Within patient's normal limits.

Action Threshold: Significant changes indicating fluid overload (e.g., hypertension, tachycardia) or dehydration (e.g., hypotension, tachycardia).

Physical Assessment (Edema, Lung Sounds, Skin Turgor)

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

Target: Absence of new edema, clear lung sounds, normal skin turgor.

Action Threshold: Development of peripheral or pulmonary edema, crackles, or signs of dehydration.

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Symptom Monitoring

  • Signs of fluid overload: peripheral edema, pulmonary edema (dyspnea, crackles, orthopnea), weight gain, hypertension, jugular venous distension.
  • Signs of hypernatremia: thirst, lethargy, weakness, irritability, seizures, coma.
  • Signs of electrolyte imbalance: muscle weakness, cramps, arrhythmias (less common with 0.9% NaCl unless underlying issues).

Special Patient Groups

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Pregnancy

Generally considered safe for use during pregnancy when clinically indicated for fluid and electrolyte replacement. However, large volumes should be administered with caution to avoid fluid overload, especially in pre-eclampsia or other conditions predisposing to fluid retention.

Trimester-Specific Risks:

First Trimester: Low risk, generally used as needed.
Second Trimester: Low risk, generally used as needed.
Third Trimester: Low risk, but monitor closely for fluid overload, especially in conditions like pre-eclampsia.
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Lactation

Sodium chloride is a natural component of breast milk. Administration of Sodium Chloride 0.9% Injection is considered safe during lactation and is not expected to harm the breastfed infant.

Infant Risk: L1 (Safest - no increase in risk to the breastfed infant)
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Pediatric Use

Dosing must be carefully calculated based on weight, age, and clinical condition to avoid fluid overload or electrolyte imbalances. Neonates and infants are particularly susceptible to fluid and electrolyte shifts. Close monitoring of fluid intake/output, weight, and serum electrolytes is crucial.

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Geriatric Use

Use with caution in elderly patients, who may have age-related decreases in renal function, cardiac reserve, and increased susceptibility to fluid overload and electrolyte imbalances. Start with lower doses and monitor fluid status, renal function, and electrolytes closely.

Clinical Information

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Clinical Pearls

  • Sodium Chloride 0.9% (Normal Saline) is an isotonic crystalloid solution, meaning it has a similar osmolality to human plasma.
  • It is the most commonly used intravenous fluid for volume expansion, as approximately 25% of the infused volume remains in the intravascular space.
  • Primarily used for hydration, diluent for medications, and to maintain patency of IV access devices.
  • Caution should be exercised in patients with heart failure, severe renal impairment, or conditions predisposing to sodium retention (e.g., cirrhosis, corticosteroid use) due to the risk of fluid overload and hypernatremia.
  • While 'normal saline,' prolonged or excessive use can lead to hyperchloremic metabolic acidosis due to its higher chloride content compared to plasma.
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Alternative Therapies

  • Lactated Ringer's Solution (LR): Another isotonic crystalloid, often preferred for large volume resuscitation due to its more physiologic electrolyte composition and buffering agents.
  • Dextrose 5% in Water (D5W): Hypotonic solution used for free water replacement and to provide minimal calories.
  • Plasma-Lyte A: A balanced crystalloid solution with a more physiologic electrolyte profile than normal saline.
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Cost & Coverage

Average Cost: $0.50 - $5.00 per 10 mL vial/ampule
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 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; do not flush them down the toilet or pour them down the drain unless instructed to do so by your pharmacist or healthcare provider. For guidance on the best disposal method, consult your pharmacist, who may also be aware of local drug take-back programs. 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 it was taken to ensure prompt and effective treatment.