SODIUM CHLORIDE 3% = NaCl 3%

Indications

• Severe symptomatic hyponatraemia: serum sodium level < 120 mmol/litre with neurologic involvement (e. g. seizures, confusional state, coma)
• Increased intracranial pressure in traumatic brain injury 
• Cerebral oedema

Forms and strengths, route of administration

• 500 ml bag, for IV infusion on central line or large peripheral vein, preferably using an infusion pump.
• DO NOT ADMINISTER BY IV, IM or SC INJECTION.

Composition

• Hypertonic solution of sodium chloride (3 g per 100 ml, 15 g in 500 ml)
• Ionic composition:
  • sodium (Na⁺) 513 mmol (513 mEq) per litre
  • chloride (Cl^–) 513 mmol (513 mEq) per litre
• Osmolarity: 1027 mOsmol per litre

Dosage and duration

Dosage varies according to patient’s underlying condition, severity of symptoms, clinical response and serum sodium level. For information:

Severe symptomatic hyponatraemia

• Child under 50 kg: 3 ml/kg over 20 minutes
• Child 50 kg and over and adult: 150 ml over 20 minutes

Check clinical response and serum sodium level. Repeat infusion up to 2 times if necessary during the first hour, until symptoms improve or serum sodium increases by 5 mmol/litre.

Further correction of hyponatremia is based on serum sodium deficit calculation, to reach 130 mmol/litre.

Do not increase serum sodium by more than 10 mmol/litre in the first 24 hours and 8 mmol/litre per 24 hours thereafter.

Increased intracranial pressure in traumatic brain injury, cerebral oedema

• Child and adult: 3 ml/kg over 10 to 20 minutes

Repeat infusion up to 2 times if necessary, according to clinical response. 

Contra-indications, adverse effects, precautions

• Administer with caution and under close supervision:
  • to infants and older patients;
  • to patients with conditions associated with sodium or fluid retention (hypertension, heart failure, peripheral or pulmonary oedema, renal impairment, hepatic impairment with cirrhosis, pre-eclampsia, etc.) or taking drugs that increase the risk of sodium or fluid retention (e.g. corticosteroids);
  • if serum sodium > 160 mmol/litre or serum osmolarity > 320 mOsm/litre.
• May cause:
  • pain at infusion site, venous irritation, phlebitis, necrosis in the event of extravasation;
  • nausea, vomiting, diarrhoea, dry eyes and mouth, thirst, headache;
  • electrolytes disturbances (hypernatraemia, hypokalaemia, hyperchloraemia) and acid-base imbalance;
  • in the event of too rapid infusion and/or overcorrection of hyponatraemia:
    • peripheral or pulmonary oedema;
    • osmotic demyelination syndrome (signs and symptoms include dysphagia, confusional state, slurred speech, movement disorders, lethargy, muscle weakness and coma).
• Closely monitor:
  • infusion rate; use an infusion pump to prevent unintentional bolus;
  • infusion site for redness and inflammation;
  • clinical and neurologic state, serum sodium level (and other electrolytes if possible);
  • urine output: a sudden increase to more than 100 ml/hour may be an early sign of hyponatraemia overcorrection.
• Pregnancy and breast-feeding: administer only if clearly needed. 

Remarks

• Do not use as a vehicle for administering injectable drugs, use 0.9% sodium chloride.
• 3% sodium chloride is not included in the WHO list of essential medicines.

Storage

Below 25 °C