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Sodium Chloride 2.5meq/ml Inj, 40ml

Manufacturer FRESENIUS KABI USA 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
Electrolyte replacement; Fluid and electrolyte balance agent
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Pharmacologic Class
Electrolyte; Hypertonic 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 is a salt solution given through a vein (intravenously). It's used to replace salt and water in your body, especially if your salt levels are very low or if you need extra fluids. This specific solution is very concentrated and is used for serious conditions, not for everyday hydration.
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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 to you. It is essential to follow the 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 to receive guidance on what to do next.
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Lifestyle & Tips

  • This medication is administered in a hospital or clinical setting and does not typically require specific lifestyle changes.
  • Report any unusual symptoms or discomfort immediately to your healthcare provider.
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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 desired rate of sodium correction. This concentrated solution (2.5 mEq/mL or 14.6% NaCl) is typically used for severe, symptomatic hyponatremia or to prepare custom IV solutions. For severe symptomatic hyponatremia, initial boluses of 10-20 mL (25-50 mEq) of this solution may be administered slowly over 10-20 minutes, with frequent monitoring of serum sodium. Subsequent dosing is guided by serum sodium levels and clinical response, aiming for a controlled increase.

Condition-Specific Dosing:

severe_symptomatic_hyponatremia: Initial bolus of 10-20 mL (25-50 mEq) administered slowly over 10-20 minutes. Repeat as needed with frequent serum sodium monitoring. Target increase: 4-6 mEq/L in first 24 hours, not exceeding 8-10 mEq/L in 24 hours to prevent osmotic demyelination syndrome (ODS).
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Pediatric Dosing

Neonatal: Not established for routine use; highly individualized for severe hyponatremia under expert supervision. Dosing typically calculated based on weight and sodium deficit, aiming for slow, controlled correction.
Infant: Not established for routine use; highly individualized for severe hyponatremia under expert supervision. Dosing typically calculated based on weight and sodium deficit, aiming for slow, controlled correction.
Child: Not established for routine use; highly individualized for severe hyponatremia under expert supervision. Dosing typically calculated based on weight and sodium deficit, aiming for slow, controlled correction.
Adolescent: Similar to adult principles, highly individualized for severe hyponatremia under expert supervision. Dosing typically calculated based on weight and sodium deficit, aiming for slow, controlled correction.
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Dose Adjustments

Renal Impairment:

Mild: Use with caution; monitor fluid and electrolyte status closely.
Moderate: Use with caution; monitor fluid and electrolyte status closely. Increased risk of fluid overload and hypernatremia.
Severe: Use with extreme caution; monitor fluid and electrolyte status closely and frequently. Significant risk of fluid overload and hypernatremia. Dosing must be highly individualized and may require reduced rates or volumes.
Dialysis: Considerations for patients on dialysis depend on their interdialytic weight gain and electrolyte status. Sodium chloride administration should be carefully managed to avoid fluid overload and hypernatremia, often guided by dialysis prescription and post-dialysis labs.

Hepatic Impairment:

Mild: No specific dose adjustment required, but monitor fluid and electrolyte status due to potential for altered fluid balance in liver disease.
Moderate: No specific dose adjustment required, but monitor fluid and electrolyte status due to potential for altered fluid balance in liver disease.
Severe: No specific dose adjustment required, but monitor fluid and electrolyte status due to potential for altered fluid balance (e.g., ascites, edema) in severe liver disease.

Pharmacology

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Mechanism of Action

Sodium chloride is the principal extracellular cation and anion, respectively, and plays a vital role in maintaining fluid and electrolyte balance, osmotic pressure, and acid-base balance. Administered intravenously, it provides essential electrolytes and water, helping to restore or maintain intravascular volume and correct electrolyte imbalances, particularly hyponatremia. The 2.5 mEq/mL concentration provides a hypertonic solution, which can draw water from the intracellular space into the extracellular space, increasing serum sodium concentration and reducing cerebral edema.
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Pharmacokinetics

Absorption:

Bioavailability: 100% (intravenous administration)
Tmax: Rapid (immediate distribution upon IV infusion)
FoodEffect: Not applicable (IV administration)

Distribution:

Vd: Approximately 0.2 L/kg (distributes primarily in the extracellular fluid space)
ProteinBinding: Not applicable (sodium and chloride ions do not bind to plasma proteins)
CnssPenetration: Yes (ions cross the blood-brain barrier, but movement is regulated)

Elimination:

HalfLife: Not applicable (ions are continuously regulated by renal and hormonal mechanisms)
Clearance: Primarily renal clearance, regulated by glomerular filtration and tubular reabsorption.
ExcretionRoute: Renal (urine), sweat, feces
Unchanged: 100% (excreted as ions)
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Pharmacodynamics

OnsetOfAction: Immediate (upon intravenous administration)
PeakEffect: Within minutes to hours, depending on rate of administration and patient's fluid/electrolyte status.
DurationOfAction: Variable, depends on patient's renal function, fluid intake, and ongoing losses. Effects on serum sodium are sustained as long as infusion continues and renal excretion is balanced.
Confidence: High

Safety & Warnings

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Side Effects

Urgent Side Effects: Seek Medical Help Right Away

While rare, some people may experience severe and potentially life-threatening side effects when 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 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. However, many people do not experience any side effects or only have mild ones. If you have any side effects that bother you or do not go away, contact your doctor for advice. Not all possible side effects are listed here. If you have questions or concerns about side effects, talk to your doctor.

Reporting Side Effects

You can report side effects 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 answering any questions you may have.
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Seek Immediate Medical Attention If You Experience:

  • Excessive thirst
  • Feeling very tired or weak
  • Confusion or changes in thinking
  • Muscle twitching or weakness
  • Seizures
  • Swelling in your hands, ankles, or feet
  • Difficulty breathing or shortness of breath
  • Headache, nausea, or vomiting (especially if new or worsening)
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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. Additionally, share any existing health problems to ensure safe treatment.

To guarantee your safety, do not initiate, discontinue, or modify the dosage of any medication without first consulting your doctor. It is vital to verify that this medication can be taken safely in conjunction with 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 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 kidney problems or if you are a premature infant. Be sure to discuss this potential risk with your doctor.

If you are pregnant, planning to become pregnant, or are breastfeeding, inform 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:

  • Hypernatremia (excessively high sodium levels): severe thirst, lethargy, irritability, muscle twitching, seizures, coma, brain damage.
  • Fluid overload: edema (swelling), pulmonary edema (fluid in lungs leading to shortness of breath, crackles), elevated blood pressure, heart failure.
  • Osmotic Demyelination Syndrome (ODS): a severe neurological disorder that can occur if chronic hyponatremia is corrected too rapidly, leading to symptoms like dysarthria, dysphagia, quadriparesis, and coma.

What to Do:

Immediate medical attention is required. Management involves discontinuing the infusion, administering free water (e.g., D5W) to lower sodium levels, and potentially diuretics to manage fluid overload. For ODS, supportive care is crucial. Call 911 or Poison Control (1-800-222-1222) immediately.

Drug Interactions

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Major Interactions

  • Corticosteroids (may increase sodium and fluid retention, exacerbating hypernatremia or fluid overload)
  • Lithium (sodium depletion can increase lithium reabsorption and toxicity; conversely, sodium loading can increase lithium excretion and reduce efficacy)
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Moderate Interactions

  • Diuretics (especially loop diuretics, can alter sodium and fluid balance, requiring careful monitoring)
  • Drugs that cause sodium retention (e.g., NSAIDs, some antihypertensives)

Monitoring

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Baseline Monitoring

Serum Electrolytes (Sodium, Potassium, Chloride)

Rationale: To establish baseline electrolyte status and guide initial dosing, especially for hyponatremia.

Timing: Prior to initiation of therapy.

Renal Function (BUN, Creatinine)

Rationale: To assess kidney's ability to excrete sodium and water, influencing dosing and risk of complications.

Timing: Prior to initiation of therapy.

Fluid Status (Vital Signs, I&O, Physical Exam)

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

Timing: Prior to initiation of therapy.

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Routine Monitoring

Serum Sodium

Frequency: Every 2-4 hours initially, then less frequently as stable, or as clinically indicated.

Target: Gradual increase, typically 4-6 mEq/L in first 24 hours, not exceeding 8-10 mEq/L in 24 hours.

Action Threshold: If sodium rises too rapidly (>8-10 mEq/L in 24h), stop infusion and consider free water administration or desmopressin to prevent ODS.

Serum Potassium, Chloride, Bicarbonate

Frequency: Daily or as clinically indicated.

Target: Within normal limits.

Action Threshold: Correct any significant imbalances.

Fluid Balance (Intake and Output)

Frequency: Every 4-8 hours or continuously.

Target: Appropriate balance based on clinical status.

Action Threshold: Significant positive or negative balance may indicate need for adjustment.

Vital Signs (BP, HR, RR)

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

Target: Within patient's normal range.

Action Threshold: Changes may indicate fluid overload or hypovolemia.

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Symptom Monitoring

  • Signs of hypernatremia (thirst, lethargy, irritability, seizures, coma)
  • Signs of fluid overload (edema, dyspnea, crackles, elevated blood pressure, jugular venous distension)
  • Neurological changes (headache, nausea, vomiting, confusion, seizures, altered mental status - especially important for monitoring for osmotic demyelination syndrome if sodium corrected too rapidly)

Special Patient Groups

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Pregnancy

Sodium chloride is generally considered safe for use during pregnancy when clinically indicated, as it is an essential electrolyte. However, fluid and electrolyte balance must be carefully monitored to avoid complications for both mother and fetus. The concentrated nature of this solution necessitates extreme caution.

Trimester-Specific Risks:

First Trimester: No specific increased risk identified beyond general fluid/electrolyte management.
Second Trimester: No specific increased risk identified beyond general fluid/electrolyte management.
Third Trimester: No specific increased risk identified beyond general fluid/electrolyte management. Careful monitoring for fluid overload is important, especially in pre-eclampsia.
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Lactation

Sodium chloride is considered safe for use during lactation. It is a natural component of breast milk, and administration of intravenous sodium chloride is unlikely to pose a risk to the nursing infant.

Infant Risk: L1 (Safest - no increase in adverse effects in the infant)
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Pediatric Use

Use with extreme caution. Dosing must be precisely calculated based on weight, sodium deficit, and desired rate of correction. Children, especially neonates and infants, are more susceptible to fluid and electrolyte imbalances and the risks of rapid sodium correction (e.g., ODS). Close monitoring of serum sodium and neurological status is critical.

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Geriatric Use

Use with caution. Elderly patients may have impaired renal function, pre-existing cardiovascular disease, and altered fluid regulation, increasing their susceptibility to fluid overload, hypernatremia, and other electrolyte imbalances. Close monitoring of fluid status, electrolytes, and renal function is essential. Start with lower doses and slower rates of infusion.

Clinical Information

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Clinical Pearls

  • This 2.5 mEq/mL (14.6%) Sodium Chloride solution is a highly concentrated product and is NOT for direct intravenous infusion. It must be diluted or administered very slowly and cautiously, often via a central line, and only for specific indications like severe symptomatic hyponatremia.
  • Rapid correction of chronic hyponatremia (serum sodium <120 mEq/L for >48 hours) carries a significant risk of Osmotic Demyelination Syndrome (ODS). The rate of sodium correction should not exceed 8-10 mEq/L in 24 hours, and ideally 4-6 mEq/L in the first 24 hours.
  • Frequent monitoring of serum sodium (every 2-4 hours initially) is paramount during administration of hypertonic saline.
  • Consider co-administration of desmopressin in patients at high risk for ODS (e.g., alcoholics, malnourished, liver disease) or if sodium correction is occurring too rapidly.
  • Always assess patient's volume status (hypovolemic, euvolemic, hypervolemic) to guide appropriate fluid management alongside sodium correction.
  • This solution can also be used as an additive to other intravenous fluids to increase their sodium content for specific patient needs.
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Alternative Therapies

  • Normal Saline (0.9% Sodium Chloride) for less severe hyponatremia or volume expansion.
  • Other intravenous fluids (e.g., Lactated Ringer's, Dextrose solutions) for fluid replacement.
  • Vasopressin receptor antagonists (e.g., tolvaptan) for euvolemic or hypervolemic hyponatremia.
  • Fluid restriction for euvolemic or hypervolemic hyponatremia.
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Cost & Coverage

Average Cost: Relatively inexpensive (typically less than $50 per vial, varies by supplier and contract) per 40 mL vial
Generic Available: Yes
Insurance Coverage: Generally covered by most insurance plans as a necessary medical supply/medication when administered in a clinical 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 emergency medical attention. Be prepared to provide information about the medication taken, the amount, and the time of ingestion.