SODIUM CHLORIDE 23.4% IN PLASTIC CONTAINER
Clinical safety rating: safe
No 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. |
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 | 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. Hypertonic saline administration may transiently increase milk sodium content. The milk-to-plasma (M/P) ratio for sodium is approximately 1.0 due to passive diffusion. Clinically significant effects on the breastfed infant are unlikely with appropriate dosing. However, high maternal doses causing hypernatremia could theoretically lead to hypernatremia in the infant. Monitor infant for signs of salt overload. |
| Teratogenic Risk |
■ 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 |
["Hypernatremia","Hypersensitivity to sodium chloride","Fluid retention states such as congestive heart failure, pulmonary edema, or peripheral edema","Severe renal impairment with oliguria or anuria"]
| 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"] |
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| 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. |