SODIUM CHLORIDE 23.4%
Clinical safety rating: safe
No 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. |
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 | 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 | Compatible with breastfeeding. Sodium chloride is normally present in breast milk; M/P ratio approximately 1.0. No adverse effects expected with usual doses. |
| 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. |
■ 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 |
["Hypernatremia","Fluid overload states (e.g., pulmonary edema)","Known hypersensitivity to sodium chloride"]
| 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"] |
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| 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. |