SODIUM CHLORIDE 3% IN PLASTIC CONTAINER
Clinical safety rating
safeNo significant drug interactions Can cause hypernatremia and fluid overload.
Hypertonic sodium chloride solution (3%) increases extracellular osmolarity, drawing water from intracellular space into extracellular compartment via osmotic gradient, thereby reducing cerebral edema and intracranial pressure. Sodium ions also restore electrolyte balance in hyponatremia.
| Metabolism | Sodium chloride is not metabolized; it is distributed in extracellular fluid and excreted primarily by the kidneys. No hepatic metabolism. |
| Excretion | Renal (essentially 100%): sodium and chloride ions are excreted unchanged in urine. No biliary or fecal elimination of intact drug; sodium and chloride are obligately filtered and variably reabsorbed based on volume status and renal function. |
| Half-life | Not applicable: sodium and chloride are endogenous electrolytes; administered dose mixes with body pools and is eliminated via renal excretion with a half-life dependent on renal function and hydration status. In euvolemic individuals with normal renal function, the terminal elimination half-life of excess sodium is approximately 6–12 hours. |
| Protein binding | 0%: sodium and chloride ions are not protein bound. |
| Volume of Distribution | Total body water (0.6 L/kg): sodium distributes primarily in extracellular fluid (0.2 L/kg); chloride distributes similarly. Clinical meaning: reflects rapid equilibration with the extracellular space. |
| Bioavailability | Intravenous: 100% (bioequivalent to endogenous electrolytes). No oral or other relevant routes for hypertonic saline; oral administration would have variable absorption and is not used. |
| Onset of Action | Intravenous: immediate (seconds to minutes); correction of hyponatremia begins upon infusion. No other routes. |
| Duration of Action | Intravenous: variable (hours); duration depends on infusion rate, volume of distribution, and renal excretion. A single dose transiently expands extracellular fluid volume and increases serum sodium; effects last until excess sodium and water are excreted. |
| Molecular Weight | 58.44 |
Intravenous infusion of 3% sodium chloride at a rate of 1-2 mL/kg/hour, with a typical rate of 50-100 mL/hour for adults, titrated to serum sodium goals. Maximum infusion rate: 100 mL/hour, with careful monitoring of serum sodium (increase not >8-10 mEq/L per 24 hours).
| Dosage form | INJECTABLE |
| Renal impairment | No specific dose adjustment for renal impairment based on GFR. Use with caution in patients with renal failure due to risk of fluid overload and hypernatremia. Monitor renal function and fluid balance closely. |
| Liver impairment | No specific dose adjustment for hepatic impairment based on Child-Pugh score. Use with caution in patients with cirrhosis due to risk of ascites and fluid overload. Monitor serum sodium and fluid status. |
| Pediatric use | Intravenous 3% sodium chloride: 0.5-1 mL/kg over 30-60 minutes, with a maximum rate of 1 mL/kg/hour, titrated to serum sodium. Typical dose for severe hyponatremia: 1-2 mL/kg/hour. Monitor serum sodium every 1-2 hours. |
| Geriatric use | Lower initial infusion rates (e.g., 25-50 mL/hour) due to decreased renal function and higher risk of fluid overload. More frequent monitoring of serum sodium and hemodynamic status. Avoid rapid correction (>8 mEq/L per 24 hours). |
| 1st trimester | Generally considered safe; used for correction of hyponatremia or fluid resuscitation. Monitor sodium levels to avoid maternal hypernatremia. |
| 2nd trimester | Same as T1; may be used for maternal indications. Avoid rapid correction to prevent osmotic demyelination. |
| 3rd trimester | Safe for maternal use; monitor fetal heart rate during administration for signs of fluid overload. |
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 passive diffusion and active transport mechanisms. The degree of transfer is directly proportional to maternal serum concentrations. |
| Breastfeeding | Sodium chloride is a normal constituent of breast milk. Administration of hypertonic solutions may transiently increase milk sodium content but is not expected to harm the infant. Use caution with high doses to avoid maternal hypernatremia, which could affect milk composition. |
| Lactation Rating | L1 (Safe) |
| Teratogenic Risk | Sodium chloride 3% is a hypertonic solution used intravenously for correction of severe hyponatremia. In pregnancy, no teratogenic effects have been reported; however, rapid correction of hyponatremia can cause osmotic demyelination syndrome, which may affect both mother and fetus. First trimester: no known teratogenic risk. Second and third trimesters: cautious use indicated as maternal fluid and electrolyte imbalances can impact fetal homeostasis. |
| Fetal Monitoring | Monitor maternal serum sodium, serum osmolality, and neurologic status closely during infusion to avoid overcorrection and osmotic demyelination. Assess fetal heart rate and uterine activity if administered for preeclampsia or other conditions. Monitor for signs of fluid overload (edema, pulmonary congestion) in mother. |
| Fertility Effects | No known direct effects on fertility. Underlying conditions requiring hypertonic saline (e.g., severe hyponatremia) may be associated with underlying endocrine or metabolic disorders that could affect fertility. |
■ FDA Black Box Warning
None
| Common Effects | fluid replacement |
| Serious Effects |
HypernatremiaFluid overload (e.g., heart failure, renal impairment with edema)Severe hypokalemia (untreated)
| Precautions | Risk of osmotic demyelination syndrome (central pontine myelinolysis) if serum sodium is corrected too rapidly; use with caution in patients with heart failure, renal impairment, or pre-existing hypernatremia; monitor serum sodium, chloride, and fluid status; avoid extravasation as it may cause tissue necrosis. |
| Food/Dietary | No direct food interactions. However, dietary sodium restriction is typically indicated in hyponatremia management, but not during active treatment with 3% saline. |
| Clinical Pearls | Hypertonic saline (3%) is used for rapid correction of symptomatic hyponatremia (e.g., seizures, coma). Infuse via central line to avoid phlebitis; use an infusion pump. Monitor serum sodium every 2-4 hours; do not exceed 8-12 mEq/L rise in 24 hours to prevent osmotic demyelination. Reserve for ICU setting. |
| Patient Advice | This medication is given intravenously to raise low sodium levels. · You will have frequent blood tests to monitor your sodium levels. · Report any new headache, confusion, or muscle weakness immediately. · Do not stop the infusion or adjust the rate on your own. |
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