SODIUM CHLORIDE 14.6%
Clinical safety rating: safe
No significant drug interactions Can cause hypernatremia and fluid overload.
Sodium chloride 14.6% is a hypertonic saline solution that increases serum osmolality, drawing water from the intracellular space into the extracellular compartment, thereby reducing cerebral edema and intracranial pressure. It also acts as a volume expander and electrolyte replenisher.
| Metabolism | Not metabolized; excreted renally as sodium and chloride ions. |
| Excretion | Renal: >90% as unchanged sodium and chloride ions; minor fecal (<5%) and negligible biliary elimination. |
| Half-life | Not applicable; sodium and chloride ions are homeostatically regulated with no defined terminal half-life. Rapidly redistributed and excreted, with clinical effect related to plasma concentration. |
| Protein binding | Negligible (<1%); no specific binding proteins. |
| Volume of Distribution | Approximately 0.4-0.7 L/kg; distributes primarily in extracellular fluid (ECF). Clinical meaning: Vd approximates ECF volume. |
| Bioavailability | Intravenous: 100%. Oral: 100% absorbed but rapidly equilibrated with ECF; bioavailability not clinically relevant for parenteral formulation. |
| Onset of Action | Intravenous: <1 minute for hemodynamic effects (volume expansion); rapid elevation of serum sodium/potent osmotic effects in hyponatremia. |
| Duration of Action | Intravenous: 30-60 minutes for acute volume expansion; osmotic effects persist until electrolyte redistribution (hours). Clinical use: continuous infusion for sustained effect. |
Intravenous infusion via central line; typical dose for severe hyponatremia is 100-150 mL over 20 minutes (150 mL max) for acute correction, then 0.5-1 mmol/L/hour increase not exceeding 8 mmol/L in 24 hours.
| Dosage form | SOLUTION |
| Renal impairment | Contraindicated in anuria; use with caution if GFR <30 mL/min due to risk of fluid overload; no specific dose adjustment but monitor serum sodium and volume status closely. |
| Liver impairment | No specific adjustment for Child-Pugh class; use caution in cirrhosis due to risk of ascites and fluid overload. |
| Pediatric use | Intravenous via central line; dose based on sodium deficit: sodium deficit (mEq) = (desired Na - current Na) × 0.6 × weight (kg). For acute severe hyponatremia, administer 3% saline at 1-2 mL/kg over 10-20 minutes, may repeat if symptoms persist. Maximum correction rate 8 mEq/L per 24 hours. |
| Geriatric use | Increased risk of fluid overload and hypernatremia; use lower initial doses and slower infusion rates (e.g., 50-100 mL over 30-60 minutes). Monitor serum sodium and volume status more frequently. |
| 1st trimester | Consult provider |
| 2nd trimester | Consult provider |
| 3rd trimester | Consult provider |
Clinical note
No significant drug interactions Can cause hypernatremia and fluid overload.
| FDA category | Animal |
| Breastfeeding | Sodium chloride is a normal constituent of breast milk. Administration of hypertonic solutions does not significantly alter milk composition. M/P ratio is not applicable as it is an endogenous substance. Use is considered compatible with breastfeeding; avoid excessive doses that could cause maternal hypernatremia and affect infant through altered milk electrolyte content. |
| Teratogenic Risk |
■ FDA Black Box Warning
None
| Common Effects | fluid replacement |
| Serious Effects |
["Hypernatremia","Hypersensitivity to sodium chloride or any component","Fluid overload (e.g., pulmonary edema, cirrhosis with ascites)","Severe renal impairment (oliguria or anuria)","Intracranial hemorrhage (relative contraindication for hypertonic saline in acute settings)"]
| Precautions | ["Risk of hypernatremia and hyperchloremic metabolic acidosis","Central pontine myelinolysis (if sodium correction is too rapid)","Extravasation risk (may cause tissue necrosis)","Use with caution in patients with heart failure, renal impairment, or edema","Monitor serum sodium, chloride, and osmolality frequently"] |
Loading safety data…
| Sodium chloride is an essential electrolyte and component of body fluids. At physiologic concentrations, it is not teratogenic. However, hypertonic sodium chloride (14.6%) is used as a hyperosmolar agent; excessive administration can cause maternal hypernatremia and dehydration, potentially leading to fetal adverse effects such as oligohydramnios, electrolyte imbalances, or osmotic stress. No human teratogenicity is documented at standard doses; animal studies show no fetal harm with balanced electrolyte solutions. |
| Fetal Monitoring | Monitor maternal serum electrolytes (sodium, chloride, osmolality) to avoid hypernatremia, especially during rapid infusion. Assess fluid balance (intake/output, weight, edema). Fetal monitoring: ultrasonography for amniotic fluid volume if administered chronically or in high doses; fetal heart rate monitoring if signs of maternal hyperosmolarity occur. |
| Fertility Effects | No known adverse effects on fertility with appropriate use. Hyperosmolar therapy may cause temporary alterations in maternal electrolyte balance but no evidence of lasting reproductive impairment. |