SODIUM CHLORIDE 23.4%
Clinical safety rating
safeNo significant drug interactions Can cause hypernatremia and fluid overload.
Hypertonic sodium chloride solution increases plasma osmolality, drawing water from intracellular to extracellular space, expanding intravascular volume, and promoting diuresis. It also provides sodium and chloride ions for electrolyte replenishment.
| Metabolism | Not metabolized; sodium and chloride ions are excreted primarily by the kidneys. |
| Excretion | Renal: >95% as sodium and chloride ions; negligible biliary/fecal. |
| Half-life | Not applicable as sodium chloride is an electrolyte; distribution and elimination follow body sodium homeostasis, with renal regulation having a half-life of hours to days depending on volume status. |
| Protein binding | 0%; not bound to plasma proteins. |
| Volume of Distribution | 0.6–0.7 L/kg; distributes into extracellular fluid. |
| Bioavailability | Oral: 100% (passive absorption); IV: 100%. |
| Onset of Action | IV: Immediate (within seconds) for hemodynamic effects; oral: 30–60 minutes for gastrointestinal absorption. |
| Duration of Action | IV: 1–2 hours for plasma expansion; oral: sustained as long as intake matches renal excretion. |
| Molecular Weight | 58.44 |
Severe hyponatremia: 100-150 mL of 23.4% sodium chloride (27-40 g NaCl) IV over 1-2 hours via central line; maximum rate 1-2 mL/min. Repeat dose based on serum sodium levels. Not for direct IV push; must be diluted or used via central line.
| Dosage form | SOLUTION |
| Renal impairment | No standard GFR-based dose adjustment; use caution in renal impairment due to risk of fluid overload and hypernatremia. Monitor serum electrolytes and volume status closely. |
| Liver impairment | No specific Child-Pugh based adjustment; use with caution in cirrhosis with ascites due to fluid overload risk. Monitor sodium and volume. |
| Pediatric use | Severe symptomatic hyponatremia: 0.5-1 mL/kg of 23.4% sodium chloride (115-230 mg NaCl/kg) IV over 1-2 hours; maximum 100 mL. Administer via central line. Repeat based on serum sodium correction. |
| Geriatric use | Use lowest effective dose; monitor for fluid overload, hypernatremia, and cardiac decompensation. Dose same as adult but adjust for renal function and comorbidities. Consider slower infusion rate. |
| 1st trimester | Generally considered safe; sodium is an essential electrolyte, but hypernatremia should be avoided. Use only when clearly indicated. |
| 2nd trimester | Generally considered safe; monitor serum sodium to avoid maternal hypernatremia which may affect fetal fluid balance. |
| 3rd trimester | Generally considered safe; caution in preeclampsia or fluid overload. Avoid rapid correction of hyponatremia. |
Clinical note
No significant drug interactions Can cause hypernatremia and fluid overload.
| FDA category | Animal |
| Placental transfer | Sodium and chloride ions freely cross the placenta via active transport and diffusion; maternal levels directly affect fetal levels. |
| Breastfeeding | Sodium chloride is a normal constituent of breast milk. Administration of hypertonic solutions may transiently increase milk sodium, but no adverse effects reported. |
| Lactation Rating | L1 (Safe) |
| Teratogenic Risk | No known teratogenic risk; sodium chloride is a normal blood constituent. However, hypernatremia from high doses may cause fetal dehydration. First trimester: no fetal risk. Second/third trimesters: monitor maternal serum sodium to avoid hypernatremia, which can cause fetal osmotic shifts. |
| Fetal Monitoring | Monitor serum sodium, chloride, and osmolarity; watch for signs of hypernatremia (e.g., thirst, confusion, seizures). In pregnancy, assess fluid balance, fetal heart rate, and amniotic fluid volume if large volumes given. |
| Fertility Effects | No known effects on fertility. Sodium chloride is essential for homeostasis; high doses may transiently alter fluid balance but no evidence of reproductive impairment. |
■ FDA Black Box Warning
Not FDA-approved for injection; extravasation causes severe tissue necrosis. Use extreme caution to avoid extravasation during administration.
| Common Effects | fluid replacement |
| Serious Effects |
HypernatremiaFluid overloadPulmonary edema
| Precautions | Risk of central pontine myelinolysis (osmotic demyelination) with rapid correction of hyponatremia, Extravasation hazard leading to tissue necrosis, May cause fluid overload, hypernatremia, and hyperchloremic metabolic acidosis, Use with caution in patients with heart failure, renal impairment, or edema |
| Food/Dietary | Dietary restrictions typically involve avoiding high-sodium foods if concurrent salt supplementation is not needed. Patients with hyponatremia may need controlled sodium intake; follow specific dietary guidelines from your provider. Avoid excessive fluid intake as it may dilute sodium levels. |
| Clinical Pearls | 23.4% sodium chloride is a hypertonic solution for severe hyponatremia or cerebral edema; administer via central line due to high osmolarity (8000 mOsm/L) to avoid phlebitis. Monitor serum sodium closely — correct at 4-6 mEq/L over 24 hours to prevent osmotic demyelination. Use with extreme caution in heart failure, renal impairment, or hypovolemia. Do not mix with medications. |
| Patient Advice | This medication is a concentrated salt solution given through a large vein to increase sodium levels in your blood. · You will need frequent blood tests to monitor your sodium and other electrolyte levels. · You may experience headache, nausea, or swelling at the injection site; report these to your healthcare provider immediately. · Notify your doctor if you have a history of heart failure, kidney disease, or if you are on a low-salt diet. · Avoid drinking excessive amounts of water during treatment unless directed by your doctor. |
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