SODIUM CHLORIDE 23.4% IN PLASTIC CONTAINER
Clinical safety rating
safeNo significant drug interactions Can cause hypernatremia and fluid overload.
Sodium chloride 23.4% is a hypertonic saline solution that increases serum osmolality, drawing water from intracellular space into extracellular space, thereby expanding intravascular volume and reducing cerebral edema. It also acts as an electrolyte replenisher.
| Metabolism | Sodium and chloride are not metabolized; they are excreted primarily by the kidneys. |
| Excretion | Renal; >95% of administered sodium and chloride ions excreted unchanged in urine via glomerular filtration and tubular reabsorption/regulation; negligible biliary/fecal elimination. |
| Half-life | Not applicable as a terminal elimination half-life; sodium and chloride are electrolytes regulated by homeostatic mechanisms; plasma concentrations normalize within minutes to hours depending on volume status and renal function. |
| Protein binding | Minimal to none; sodium and chloride are not significantly bound to plasma proteins (<0.1% bound). |
| Volume of Distribution | Approximately 0.15-0.3 L/kg; corresponds to extracellular fluid volume; sodium distributes primarily in extracellular space with minimal intracellular penetration. |
| Bioavailability | Intravenous: 100%; no oral or other relevant routes for the 23.4% hypertonic solution; oral bioavailability not applicable due to enteral use of different formulations. |
| Onset of Action | Intravenous: within seconds to minutes for correction of severe hyponatremia or volume expansion; clinical effect (serum sodium increase) observed within 15-30 minutes. |
| Duration of Action | Intravenous: variable, typically 1-4 hours depending on dose, rate of administration, and renal function; sustained effect requires continuous infusion or repeated dosing; used for acute correction of electrolyte imbalances. |
| Molecular Weight | 58.44 |
IV: 50-100 mL of 23.4% sodium chloride (11.7-23.4 g NaCl) infused over 1-2 hours for hyponatremia; rate not to exceed 0.5 mEq/L/h correction.
| Dosage form | INJECTABLE |
| Renal impairment | GFR >60: no adjustment; GFR 30-59: caution, monitor sodium; GFR 15-29: avoid if possible; GFR <15: contraindicated. |
| Liver impairment | Child-Pugh A/B: standard dosing with caution; Child-Pugh C: avoid due to risk of fluid overload and encephalopathy. |
| Pediatric use | For hyponatremia: 0.5-1 mL/kg 23.4% NaCl (2-4 mEq/kg) IV over 1-2 hours; max 100 mL/dose. Correction rate max 0.5 mEq/L/h. |
| Geriatric use | Initiate at lower end of adult dose; monitor volume status and serum sodium closely due to reduced renal function and higher risk of fluid overload. |
| 1st trimester | Sodium chloride 23.4% is a hypertonic solution used for electrolyte replacement. It is generally considered safe in pregnancy when used as indicated, but hypertonic solutions may cause fluid and electrolyte disturbances; use only if clearly needed. |
| 2nd trimester | Same as T1; no known teratogenic effects at therapeutic doses, but careful monitoring of maternal electrolytes and fluid balance is required. |
| 3rd trimester | Use with caution near term; excessive sodium or volume expansion could affect maternal hemodynamics. No known fetal harm from appropriate use. |
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; the drug is identical to endogenous electrolytes. Transfer is dependent on maternal plasma concentrations. |
| Breastfeeding | Sodium chloride is a normal component of breast milk. Administration of hypertonic solutions may transiently increase sodium levels in milk, but is unlikely to cause adverse effects in the infant at standard doses. Monitor infant for signs of electrolyte imbalance if maternal doses are high. |
| Lactation Rating | L1 (Compatible) |
| Teratogenic Risk | SODIUM CHLORIDE 23.4% is a hypertonic saline solution used for correction of severe hyponatremia or as an osmotic agent. Teratogenicity is not expected from sodium chloride itself; however, rapid correction of hyponatremia may cause maternal osmotic demyelination, which could secondarily affect fetal well-being. No direct fetal risks are documented in the first trimester. In second and third trimesters, excessive sodium administration may cause maternal hypernatremia and volume expansion, potentially leading to placental edema or fetal hypernatremia. Use cautiously and avoid extreme electrolyte shifts. |
| Fetal Monitoring | Monitored parameters include: serum sodium levels every 2-4 hours during infusion; serum osmolality; urine output; blood pressure for signs of volume overload; fetal heart rate monitoring (non-stress test) if significant electrolyte disturbances occur; signs of maternal pulmonary edema due to hypertonic load. |
| Fertility Effects | No known adverse effects on fertility. Sodium chloride is ubiquitous in physiology and does not impair reproductive function at therapeutic doses. Hypertonic saline is used in acute care settings and is unlikely to have chronic effects on fertility. |
■ FDA Black Box Warning
Rapid correction of chronic hyponatremia (>0.5 mEq/L/h) may cause osmotic demyelination syndrome (central pontine myelinolysis). Infusion rate must be carefully monitored.
| Common Effects | fluid replacement |
| Serious Effects |
HypernatremiaHyperchloremiaFluid overload (e.g., congestive heart failure, pulmonary edema)Severe renal impairment with oliguria
| Precautions | Risk of fluid overload, especially in patients with heart failure, renal impairment, or cirrhosis, Risk of hypernatremia and hyperchloremic metabolic acidosis with excessive administration, Extravasation may cause tissue necrosis, Use with caution in patients with impaired renal function, electrolyte abnormalities, or conditions predisposing to fluid overload |
| Food/Dietary | No specific food interactions. Maintain a consistent dietary sodium intake as advised by your healthcare provider; avoid excessive water intake during treatment. |
| Clinical Pearls | 23.4% sodium chloride is a hypertonic solution used primarily for severe hyponatremia (serum Na+ <120 mEq/L with neurological symptoms). Administer via central line only due to high osmolarity (8000 mOsm/L). Infuse at 1-2 mL/min with frequent serum Na+ monitoring; target correction rate ≤8 mEq/L in 24 hours to prevent osmotic demyelination syndrome. Do not use in patients with heart failure, renal impairment, or hypervolemia. |
| Patient Advice | This medication is used to correct severely low sodium levels in the blood. · It must be given through a large vein (central line) to prevent damage to small veins. · Your sodium levels and neurological status will be monitored closely during infusion. · Report any symptoms like headache, nausea, confusion, or muscle twitching immediately. · Do not adjust the infusion rate yourself; it is controlled by medical staff. |
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