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Sodium Chloride 4meq/ml (23.4%) Inj

Manufacturer HOSPIRA 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 Replenisher; Fluid and Electrolyte Balance Agent
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Pharmacologic Class
Electrolyte; Osmotic Agent
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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 medicine is a very strong salt solution given directly into your vein. It is used in emergency situations to quickly raise very low salt levels in your blood, which can cause serious brain problems, or to reduce swelling in the brain.
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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. Inspect the solution carefully before use. 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.

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 immediately to determine the best course of action.
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Lifestyle & Tips

  • This medication is typically used in acute, hospital settings and does not require specific lifestyle modifications from the patient. Focus is on monitoring and managing the underlying condition.
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Available Forms & Alternatives

Available Strengths:

Dosing & Administration

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Adult Dosing

Standard Dose: For severe, symptomatic hyponatremia: 100 mL (400 mEq Sodium) of 23.4% NaCl IV over 10-20 minutes. May be repeated once if symptoms persist. Target initial increase in serum sodium of 4-6 mEq/L in the first 24 hours. For cerebral edema/increased ICP: 30-60 mL (120-240 mEq Sodium) IV over 15-30 minutes, as needed.

Condition-Specific Dosing:

severe_symptomatic_hyponatremia: Initial bolus of 100 mL over 10-20 minutes, repeated once if needed. Subsequent management involves slower infusions to achieve target correction rates (e.g., 0.5-1 mEq/L/hour, not exceeding 8-12 mEq/L in 24 hours).
cerebral_edema_increased_ICP: 30-60 mL over 15-30 minutes, as needed for acute reduction of intracranial pressure.
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Pediatric Dosing

Neonatal: Not established for routine use; use with extreme caution and precise weight-based calculations for severe, symptomatic hyponatremia (e.g., 2-4 mL/kg of 3% NaCl, or equivalent mEq of 23.4% NaCl diluted, over 10-30 minutes).
Infant: Not established for routine use; use with extreme caution and precise weight-based calculations for severe, symptomatic hyponatremia (e.g., 2-4 mL/kg of 3% NaCl, or equivalent mEq of 23.4% NaCl diluted, over 10-30 minutes).
Child: For severe, symptomatic hyponatremia: 2-4 mL/kg of 3% NaCl (or equivalent mEq of 23.4% NaCl diluted) IV over 10-30 minutes. Max 100 mL per dose. Subsequent management involves slower infusions. For cerebral edema/increased ICP: 0.5-1 mL/kg of 23.4% NaCl IV over 15-30 minutes.
Adolescent: Similar to adult dosing for severe, symptomatic hyponatremia or cerebral edema, with careful consideration of weight and fluid status.
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Dose Adjustments

Renal Impairment:

Mild: Monitor serum sodium and fluid status closely. No specific dose adjustment, but increased risk of fluid overload.
Moderate: Monitor serum sodium and fluid status closely. No specific dose adjustment, but increased risk of fluid overload.
Severe: Use with extreme caution. Increased risk of fluid overload, hypernatremia, and pulmonary edema. Close monitoring of serum sodium, fluid balance, and renal function is critical.
Dialysis: Generally avoided in patients on dialysis unless specifically indicated for severe hyponatremia or cerebral edema, and under strict medical supervision. Dialysis itself can correct electrolyte imbalances.

Hepatic Impairment:

Mild: Monitor serum sodium and fluid status closely. No specific dose adjustment.
Moderate: Monitor serum sodium and fluid status closely. No specific dose adjustment.
Severe: Monitor serum sodium and fluid status closely. Patients with severe liver disease (e.g., cirrhosis with ascites) may have altered fluid and electrolyte balance; use with caution and monitor for fluid overload.

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. Administration of hypertonic sodium chloride (23.4%) increases serum sodium concentration and serum osmolality, leading to a shift of water from the intracellular compartment (including brain cells) to the extracellular compartment. This reduces cellular swelling, particularly in the brain, making it useful for severe hyponatremia and cerebral edema.
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Pharmacokinetics

Absorption:

Bioavailability: 100%
Tmax: Immediate
FoodEffect: Not applicable

Distribution:

Vd: Distributes primarily within the extracellular fluid compartment (approximately 0.2 L/kg for sodium).
ProteinBinding: Not protein-bound
CnssPenetration: Yes, but equilibration across the blood-brain barrier is slower than in other tissues, which is crucial for its osmotic effect on brain cells.

Elimination:

HalfLife: Not applicable (regulated by homeostatic mechanisms)
Clearance: Primarily renal excretion, regulated by glomerular filtration and tubular reabsorption.
ExcretionRoute: Renal
Unchanged: 100%
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Pharmacodynamics

OnsetOfAction: Immediate (within minutes for osmotic effect)
PeakEffect: Minutes to hours, depending on dose and patient's physiological response.
DurationOfAction: Variable, depends on patient's fluid and electrolyte status, renal function, and ongoing fluid losses/intake. Homeostatic mechanisms continuously regulate sodium and water balance.

Safety & Warnings

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Side Effects

Serious 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 or seek medical attention immediately:

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, significant weight gain, or 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:

  • Any new or worsening confusion, drowsiness, or difficulty speaking.
  • New weakness or difficulty moving arms or legs.
  • Shortness of breath or difficulty breathing.
  • Swelling in your ankles, feet, or hands.
  • Headache or dizziness.
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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 adjust 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.

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

Regular blood tests will be necessary, as directed by your doctor, to monitor your health while taking this medication. Be sure to follow your doctor's 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, notify your doctor. It is crucial to discuss the potential benefits and risks of this medication to both you and your baby, allowing for an informed decision about its use.
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Overdose Information

Overdose Symptoms:

  • Hypernatremia (excessively high blood sodium levels)
  • Fluid overload (e.g., pulmonary edema, peripheral edema, hypertension)
  • Metabolic acidosis
  • Central pontine myelinolysis / Osmotic Demyelination Syndrome (ODS) - delayed onset neurological deficits (e.g., dysarthria, dysphagia, quadriparesis, locked-in syndrome)
  • Seizures
  • Coma

What to Do:

Immediate medical attention is required. Management involves discontinuing the infusion, administering hypotonic fluids (e.g., D5W) to lower serum sodium, and potentially diuretics to manage fluid overload. In severe cases of ODS, supportive care is paramount. Call 1-800-222-1222 (Poison Control) for specific 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
  • Conditions where rapid sodium correction is not indicated (e.g., chronic asymptomatic hyponatremia)
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Major Interactions

  • Corticosteroids (e.g., prednisone, hydrocortisone): May cause increased sodium and fluid retention, exacerbating hypernatremia or fluid overload risk.
  • Lithium: Sodium levels affect renal lithium excretion. Increased sodium intake/levels can decrease lithium levels, potentially reducing therapeutic effect. Decreased sodium can increase lithium levels, leading to toxicity.
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Moderate Interactions

  • Drugs causing sodium retention (e.g., NSAIDs, some antihypertensives): May increase risk of fluid overload or hypernatremia.
  • Diuretics (especially loop diuretics): While sometimes used to manage fluid overload, concurrent use with hypertonic saline requires careful monitoring to avoid electrolyte imbalances.
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Minor Interactions

  • None specifically identified beyond general fluid and electrolyte balance considerations.

Monitoring

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Baseline Monitoring

Serum Sodium (Na+)

Rationale: To establish baseline and guide initial dosing for hyponatremia correction.

Timing: Prior to administration

Serum Osmolality

Rationale: To assess overall solute concentration and guide management of osmotic imbalances.

Timing: Prior to administration

Renal Function (BUN, Creatinine)

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

Timing: Prior to administration

Fluid Status (physical exam, weight)

Rationale: To assess for signs of fluid overload or dehydration.

Timing: Prior to administration

Neurological Status (GCS, mental status)

Rationale: To assess severity of hyponatremia symptoms and monitor for improvement or complications (e.g., ODS).

Timing: Prior to administration

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Routine Monitoring

Serum Sodium (Na+)

Frequency: Every 2-4 hours initially, then every 4-6 hours once stable, or as clinically indicated.

Target: Correction rate of 4-6 mEq/L in the first 24 hours, and no more than 8-12 mEq/L in 24 hours to prevent osmotic demyelination syndrome (ODS).

Action Threshold: If sodium rises too rapidly (>12 mEq/L in 24 hours or >18 mEq/L in 48 hours), consider stopping hypertonic saline and potentially administering D5W or desmopressin to re-lower sodium.

Fluid Balance (intake/output)

Frequency: Every 4-8 hours

Target: Maintain appropriate fluid balance, avoiding overload.

Action Threshold: Significant positive fluid balance or signs of fluid overload (e.g., new onset crackles, peripheral edema) warrant re-evaluation of fluid therapy.

Neurological Status

Frequency: Continuously or every 1-2 hours initially, then every 4-6 hours.

Target: Improvement of hyponatremia symptoms (e.g., resolution of seizures, improved mental status).

Action Threshold: Worsening neurological symptoms or new onset of neurological deficits (e.g., dysarthria, dysphagia, quadriparesis) may indicate ODS and require immediate intervention.

Vital Signs (BP, HR, RR)

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

Target: Within normal limits for patient.

Action Threshold: Significant changes (e.g., hypertension, tachycardia, tachypnea) may indicate fluid overload or other complications.

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Symptom Monitoring

  • Headache
  • Nausea/Vomiting
  • Confusion/Disorientation
  • Lethargy/Somnolence
  • Seizures
  • Coma
  • Signs of fluid overload (e.g., dyspnea, orthopnea, peripheral edema, crackles on lung auscultation)
  • Signs of osmotic demyelination syndrome (ODS): dysarthria, dysphagia, quadriparesis, pseudobulbar palsy, locked-in syndrome (typically delayed onset, days after rapid correction)

Special Patient Groups

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Pregnancy

Pregnancy Category C. Animal reproduction studies have not been conducted. Use only if the potential benefit justifies the potential risk to the fetus. Careful monitoring of maternal fluid and electrolyte status is crucial.

Trimester-Specific Risks:

First Trimester: No specific data, but general caution with any medication during organogenesis.
Second Trimester: Monitor fluid and electrolyte balance closely.
Third Trimester: Monitor fluid and electrolyte balance closely; risk of fluid overload.
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Lactation

Sodium and chloride are normal components of breast milk. Administration of hypertonic saline is unlikely to pose a significant risk to the breastfed infant, especially given its acute, short-term use. Monitor infant for any signs of electrolyte imbalance or fluid changes.

Infant Risk: Low
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Pediatric Use

Use with extreme caution. Pediatric patients, especially neonates and infants, are more susceptible to rapid fluid and electrolyte shifts and are at higher risk for osmotic demyelination syndrome (ODS) and cerebral edema/hemorrhage from inappropriate correction. Dosing must be precise and weight-based, with frequent monitoring of serum sodium and neurological status.

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Geriatric Use

Use with caution. Elderly patients may have impaired renal function, pre-existing cardiovascular disease, and altered fluid homeostasis, increasing their susceptibility to fluid overload, hypernatremia, and other complications. Close monitoring of fluid status, electrolytes, and renal function is essential.

Clinical Information

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Clinical Pearls

  • 23.4% Sodium Chloride is a highly concentrated solution (4 mEq/mL) and must be administered with extreme caution, typically via a central venous line due to its high osmolality (approximately 8000 mOsm/L), which can cause severe peripheral vein irritation and phlebitis.
  • The primary indication for 23.4% NaCl is acute, severe, symptomatic hyponatremia (e.g., seizures, coma) or for rapid reduction of intracranial pressure in cerebral edema.
  • Rapid correction of chronic hyponatremia is the leading cause of Osmotic Demyelination Syndrome (ODS), a severe and often irreversible neurological disorder. The rate of sodium correction should not exceed 8-12 mEq/L in 24 hours, and ideally 4-6 mEq/L in the first 24 hours for chronic hyponatremia.
  • Always have a clear plan for sodium correction targets and monitoring frequency before initiating hypertonic saline.
  • Consider consulting with an intensivist, nephrologist, or endocrinologist when managing severe hyponatremia with hypertonic saline.
  • In cases of overcorrection, consider administering D5W (dextrose 5% in water) or desmopressin to re-lower serum sodium and prevent ODS.
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Alternative Therapies

  • For hyponatremia: Fluid restriction (for euvolemic/hypervolemic hyponatremia), vasopressin receptor antagonists (e.g., tolvaptan, conivaptan for euvolemic/hypervolemic hyponatremia), loop diuretics (with saline for hypervolemic hyponatremia).
  • For cerebral edema: Mannitol (osmotic diuretic), hyperventilation, surgical decompression.
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Cost & Coverage

Average Cost: Relatively inexpensive per vial/ampule
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, avoid flushing medications down the toilet or pouring 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.