Parenteral: Restores sodium ion in patients with restricted oral intake (especially hyponatremia states or low salt syndrome). In general, parenteral saline uses:

Bacteriostatic sodium chloride: Dilution or dissolving drugs for I.M., I.V., or SubQ injections

Concentrated sodium chloride: Additive for parenteral fluid therapy

Hypertonic sodium chloride: For severe hyponatremia and hypochloremia

Hypotonic sodium chloride: Hydrating solution

Normal saline: Restores water/sodium losses

Pharmaceutical aid/diluent for infusion of compatible drug additives

Ophthalmic: Reduces corneal edema

Oral: Restores sodium losses

Inhalation: Restores moisture to pulmonary system; loosens and thins congestion caused by colds or allergies; diluent for bronchodilator solutions that require dilution before inhalation

Intranasal: Restores moisture to nasal membranes

Irrigation: Wound cleansing, irrigation, and flushing

Cardiovascular: Congestive conditions

Endocrine & metabolic: Extravasation, hypervolemia, hypernatremia, dilution of serum electrolytes, overhydration, hypokalemia

Local: Thrombosis, phlebitis, extravasation

Respiratory: Pulmonary edema

Symptoms of overdose include nausea, vomiting, diarrhea, abdominal cramps, hypocalcemia, hypokalemia, hypernatremia

Hypernatremia is resolved through the use of diuretics and free water replacement

Y-site administration: Compatible: Ciprofloxacin

Compatibility in syringe: Compatible: Cimetidine

Absorption: Oral, I.V.: Rapid

Distribution: Widely distributed

Excretion: Primarily urine; also sweat, tears, saliva

Children: I.V.: Hypertonic solutions (>0.9%) should only be used for the initial treatment of acute serious symptomatic hyponatremia; maintenance: 3-4 mEq/kg/day; maximum: 100-150 mEq/day; dosage varies widely depending on clinical condition

Replacement: Determined by laboratory determinations mEq

Sodium deficiency (mEq/kg) = [% dehydration (L/kg)/100 x 70 (mEq/L)] + [0.6 (L/kg) x (140 - serum sodium) (mEq/L)]

Children 2 years and Adults:

Intranasal: 2-3 sprays in each nostril as needed

Irrigation: Spray affected area

Children and Adults: Inhalation: Bronchodilator diluent: 1-3 sprays (1-3 mL) to dilute bronchodilator solution in nebulizer prior to administration

Adults:

GU irrigant: 1-3 L/day by intermittent irrigation

Heat cramps: Oral: 0.5-1 g with full glass of water, up to 4.8 g/day

Replacement I.V.: Determined by laboratory determinations mEq

Sodium deficiency (mEq/kg) = [% dehydration (L/kg)/100 x 70 (mEq/L)] + [0.6 (L/kg) x (140 - serum sodium) (mEq/L)]

To correct acute, serious hyponatremia: mEq sodium = [desired sodium (mEq/L) - actual sodium (mEq/L)] x [0.6 x wt (kg)]; for acute correction use 125 mEq/L as the desired serum sodium; acutely correct serum sodium in 5 mEq/L/dose increments; more gradual correction in increments of 10 mEq/L/day is indicated in the asymptomatic patient

Chloride maintenance electrolyte requirement in parenteral nutrition: 2-4 mEq/kg/24 hours or 25-40 mEq/1000 kcals/24 hours; maximum: 100-150 mEq/24 hours

Sodium maintenance electrolyte requirement in parenteral nutrition: 3-4 mEq/kg/24 hours or 25-40 mEq/1000 kcals/24 hours; maximum: 100-150 mEq/24 hours.

Approximate Deficits of Water and Electrolytes in Moderately Severe Dehydration1

Ophthalmic:

Ointment: Apply once daily or more often

Solution: Instill 1-2 drops into affected eye(s) every 3-4 hours

Neonates:

Full-term: 133-142 mEq/L

Premature: 132-140 mEq/L

Children 2 months to Adults: 135-145 mEq/L

Gel, intranasal (Nasal Moist®): 0.65% (30 g)

Injection, solution: 0.45% (25 mL, 50 mL, 100 mL, 250 mL, 500 mL, 1000 mL, 1500 mL, 2000 mL); 0.9% (1 mL, 2 mL, 3 mL, 5 mL, 10 mL, 20 mL, 25 mL, 30 mL, 50 mL, 100 mL, 150 mL, 250 mL, 500 mL, 1000 mL); 2.5 % (250 mL); 3% (500 mL); 5% (500 mL)

Injection, solution [preservative free]: 0.9% (2 mL, 3 mL, 5 mL, 10 mL, 20 mL, 50 mL, 100 mL)

Injection, solution, bacteriostatic: 0.9% (10 mL, 20 mL, 30 mL)

Injection, solution, concentrate: 14.6% [2.5 mEq/mL] (20 mL, 40 mL, 250 mL); 23.4% [4 mEq/mL] (30 mL, 50 mL, 100 mL, 200 mL, 250 mL)

Ointment, ophthalmic (Muro-128®): 5% (3.5 g)

Powder, for nasal solution:

Broncho Saline®: 0.9% (90 mL, 240 mL)

Entsol®: 3% (10.5 g)

Solution, for inhalation: 0.45% (3 mL, 5 mL); 0.9% (3 mL, 5 mL, 15 mL); 3% (15 mL); 10% (15 mL)

Solution, intranasal: 0.65% (45 mL)

Altamist: 0.65% (60 mL) [spray]

Ayr® Baby Saline: 0.65% (30 mL) [spray/drops]

Ayr® Saline: 0.65% (50 mL) [drops]

Ayr® Saline Mist: 0.65% (50 mL) [spray]

Breathe Right® Saline: 0.65% (44 mL) [spray]

Entsol® [preservative free]: 3% (100 mL) [spray]

Entsol® Mist: 3% (30 mL) [spray]

Enstol® Single Use [preservative free]: 3% (240 mL) [nasal wash]

Na-Zone®: 0.75% (60 mL) [spray]

NSal™: 0.65% (15 mL) [drops]; (30 mL) [spray]

Nasal Moist®: 0.65% (15 mL, 45 mL) [spray]

Ocean®: 0.65% (45 mL) [spray/drops]

Pediamist®: 0.5% (15 mL) [spray]

Pretz® Irrigation: 0.75% (240 mL)

SalineX®: 0.4% (15 mL) [drops]; (50 mL) [spray]

SeaMist®: 0.65% (15 mL) [spray]

Simply Saline™: 0.9% (44 mL) [mist]

Solution for irrigation: 0.45% (2000 mL); 0.9% (250 mL, 500 mL, 1000 mL, 1500 mL, 2000 mL, 3000 mL, 4000 mL, 5000 mL)

Wound Wash Saline™: 0.9% (90 mL, 210 mL)

Solution, ophthalmic: 5% (15 mL)

Muro-128®: 2% (15 mL), 5% (15 mL, 30 mL)

Tablet: 1 g

Barer J, Hill LL, Hill RM, et al, "Fatal Poisoning From Salt Used as an Emetic,"Am J Dis Child, 1973, 125:889-90.

Gresham GS and Mashru MK, "Fatal Poisoning With Sodium Chloride,"Forensic Sci Int, 1982, 20:87-8.

Joint Commission on Accreditation of Healthcare Organizations, "2005 National Patient Safety Goals," available at http://www.jcaho.org/accredited+organizations/patient+safety/05_npsg_guidelines Last accessed October 15, 2004.

Meadow R, "Nonaccidental Salt Poisoning,"Arch Dis Child, 1993, 68(4):448-52.

Moder KG and Hurley DL, "Fatal Hypernatremia From Exogenous Salt Intake: Report of a Case and Review of the Literature,"Mayo Clin Proc, 1990, 65(12):1587-94.

Smith EJ, and Palevsky S, "Salt Poisoning in a Two-Year-Old Child,"Am J Emerg Med, 1990, 8:571-2.