Parenteral Manual

Sodium Chloride 3% (Hypertonic)

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Alternate Name(s): 
Hypertonic saline
Original Date: 
August 2005
Revised Date: 
September 2011
Indications: 
  • Hyponatremia in patients who are symptomatic (e.g. seizures, coma) and have concentrated urine (osmolality of 200 mosm/L or greater)
  • When high sodium and/or chloride content without large amounts of fluid is/are required (e.g. electrolyte and fluid loss replaced with sodium-free fluids, excessive water intake resulting in drastic dilution of body water, emergency treatment of severe salt depletion, addisonian crisis, diabetic coma).
Reconstitution and Stability: 
  • NaCl 3% injection available in 250 mL PVC minibags
  • Store at room temperature
Compatibility: 

- No information

Administration: 

(For approved routes of administration by nursing personnel, refer to Policy for the Administration of Intravenous Medications.)

SC NO
IM NO
IV Direct YES, Central Line ONLY (can be given via PIV in emergency setting); Electrolyte and ICP monitoring
Infusion time: 5 minutes
IV Intermittent Infusion YES, Central Line ONLY (can be given via PIV in emergency setting); Electrolyte and ICP monitoring
Infusion rate: do not exceed 1 mmol/kg/hour
IV Continuous Infusion YES, Central Line ONLY (can be given via PIV in emergency setting); Electrolyte and ICP monitoring

 

Dosage: 

(For neonatal dosages, refer to Neonatal IV Drug Manual.)

Pediatric:

- Intracranial Hypertension (ICU & Emergency)

  • Bolus: 1-2 mL/kg/dose of 3% NaCl IV over 5 minutes q12h.  An initial bolus of 2-4 mL/kg can be administered prn.  Hold if serum osmolarity >305 mOsm/L
  • Continuous Infusion: 0.1-1 mL/kg/hr of 3% NaCl administered on a sliding scale.  The minimum dose needed to maintain ICP <20 mm Hg should be used.

-To correct acute, serious hyponatremia:  mmol sodium = desired sodium (mmol/L) - actual sodium (mmol/L) x 0.6 x weight (kg)
SPOT TEAM to order, administer, and remain on floor for infusion & until serum sodium reported.

Potential hazards of parenteral administration: 
  • Due to sodium excess: edema, pulmonary edema, hypertension, hyperchloremic acidosis, deep respiration, disorientation, nausea, weakness, potassium loss
  • Local pain and venous irritation with a too rapid infusion
  • Too rapid correction in sodium deficit can result in osmotic demyelination syndrome with resultant severe brain injury and potentially death
Notes: 
  • Monitor serum sodium and chloride, ins and outs, weight
  • 1 litre of NaCl 3% contains 513 mmol of sodium

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