Neonatal Drug Therapy Manual

Sodium Chloride 3% (Hypertonic)

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Updated January 26, 2022 - 6:00pm

Alternate Name(s): 
Hypertonic saline
Classification: 
Electrolyte
Original Date: 
November 2010
Indications: 
  • 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)

 

Administration: 
  • 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.

Dosage: 

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
Compatibility: 

- No information

Notes: 
  • 1 liter of NaCl 3% contains 513 mmol of sodium
References: 

- 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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