Neonatal Drug Therapy Manual

Sodium Chloride 3% (Hypertonic)

Disclaimer: Official controlled document is the CHEO and Ottawa Hospital online copy. It is the responsibility of user to ensure that any paper copy version is the same as the online version before use.

Alternate Name(s): 
Hypertonic saline
Original Date: 
November 2010
  • Treatment of serious hyponatremia defined as a serum Na < 120 mmol/L or hyponatremia in neonates presenting with symptoms such as seizures, coma or signs of brainstem herniation
  • Emergency treatment of increase intracranial pressure (ICP)


  • IV intermittent infusion
    • Central line preferred *
    • Infusion rate: (maximum rate: 1 mmol/kg/hr approximately equivalent to 2 mL/kg/hr of NaCl 3%)
  • IV Direct: In Critical Care Areas at CHEO (PICU, NICU, Emergency)
    • For emergency treatment of increase intracranial pressure (ICP)
    • Central line preferred *
    • Infusion time: over 5 minutes

* In emergency situation, may be given peripherally.  Sodium Chloride 3% is strongly hypertonic (1027 mOsm/L) and may cause vein damage.


To correct serious hyponatremia (serum Na < 120 mmol/L) or symptomatic hyponatremia:

   Dose of Na (mmol) = [desired Na (mmol/L) - actual Na (mmol/L)] x 0.6 x wt (kg)

*For acute correction use 125 mmol/L as the desired sodium

To convert above dose of Na (mmol) into mL of NaCl 3%:    

                                  dose of Na (mmol) = dose of NaCl 3% in mL
                                     0.513 mmol/mL

Emergency treatment of increase intracranial pressure:

  • 5 mL/kg/dose over 5 minutes.  Some studies have used maintenance doses of 2 mL/kg every 6 hours for 2 days following a bolus dose of 5 mL/kg
Side Effects: 
  • CNS: myelinolysis (occur more frequently if there is a rapid transition from hyponatremia to hypernatremia), subdural hematoma or effusion, rebound cerebral edema
  • CVS: edema, pulmonary edema, hypertension (due to sodium excess)
  • Endocrine and metabolic: hyperchloremic, metabolic acidosis
  • Local: phlebitis
  • Renal: Acute tubular necrosis, renal failure (higher risk with serum osmolarity > 365 mOsm/L)
Parameters to Monitor: 
  • Serum sodium and chloride, ins and outs, weight
  • BP, HR
  • Serum creatinine and urea
  • Injection site
  • Intracranial pressures (when given for raised intracranial pressure)
Reconstitution and Stability: 
  • NaCl 3% injection available in 250 mL PVC minibags

- No information

  • 1 liter of NaCl 3% contains 513 mmol of sodium

- Lau E (Editor). Drug Handbook and Formulary- the Hospital for Sick Children. Toronto: 2010-2011

- Taketomo CK, Hodding JH, Kraus DM.  Pediatric Dosage Handbook 17th Edition. Hudson: Lexi-Comp Inc.; 2010

- Upadhyay P, Tripathi VN, Singh RP, Sachan D.  Role of hypertonic saline and mannitol in the management of raised intracranial pressure in children: A randomized comparative study.  J Pediatr Neurosc 2010;5:18-21



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