Disclaimer to the Online Edition
This Manual has been designed for use in the NICU at London Health Sciences Centre (LHSC), London, Ontario, Canada, and represents clinical practice at this institution. The information contained within the Manual may not be applicable to other centres. If users of this Manual are not familiar with a drug, it is recommended that the official monograph be consulted before it is prescribed and administered. Any user of this information is advised that the contributors, Editor and LHSC are not responsible for any errors or omissions, and / or any consequences arising from the use of the information in this Manual.
sodium Chloride (NaCl)
Indication
- Used to treat or prevent hyponatremia
Dosage Guidelines
Treatment
mmol Na = [Desired Na – Actual Na (mmol/L)] x present weight (kg) x 0.6 (L/kg)
Not recommended to exceed change in serum sodium of more than 12 mmol/L in 24 hours
Prevention
- Normal requirement for preterm infants is 2-8 mmol/kg/day
- Normal requirement for term infants is 3-4 mmol/kg/day
Administration
- IV: Maximum rate 1 mmol/kg/hr
- Maximum concentration for peripheral administration is 0.154 mmol/mL (i.e. normal saline)
- Central line preferred for hypertonic 3% NaCl. Further dilution recommended.
- ORAL: must administer with feeds to avoid GI irritation
Adverse Effects
- ORAL: feeding intolerance, abdominal distention, loose stool
- IV: phlebitis
- Hypernatremia, hyperchloremia, edema, pulmonary edema
- Sodium toxicity is typically related to how fast a sodium deficit is corrected.
Comments
- Monitor serum sodium at least 12 hours after starting IV replacement and 24 to 48 hours after starting oral therapy
- Dosage depends upon the clinical condition, fluid, electrolyte and acid-base balance of the patient
- 3% NaCl is a High-Alert Medication
Supplied As
0.5 mmol/mL (3%) injection 250 mL bag
2.5 mmol/mL oral solution
References
- LexiComp Sick Kids
- LexiComp Pediatric and Neonatal