Drug reference
Severe symptomatic hyponatraemia: serum sodium level < 120 mmol/litre with neurologic involvement (e. g. seizures, confusional state, coma) Increased intracranial pressure in traumatic brain injury Cerebral oedema
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Administer with caution and under close supervision: to infants and older patients; to patients with conditions associated with sodium or fluid retention (hypertension, heart failure, peripheral or pulmonary oedema, renal impairment, hepatic impairment with cirrhosis, pre- eclampsia, etc.) or taking drugs that increase the risk of sodium or fluid retention (e.g. corticosteroids); if serum sodium > 160 mmol/litre or serum osmolarity > 320 mOsm/litre. May cause: pain at infusion site, venous irritation, phlebitis, necrosis in the event of extravasation; nausea, vomiting, diarrhoea, dry eyes and mouth, thirst, headache; electrolytes disturbances (hypernatraemia, hypokalaemia, hyperchloraemia) and acid-base imbalance; in the event of too rapid infusion and/or overcorrection of hyponatraemia: peripheral or pulmonary oedema; osmotic demyelination syndrome (signs and symptoms include dysphagia, confusional state, slurred speech, movement disorders, lethargy, muscle weakness and coma). Closely monitor: infusion rate; use an infusion pump to prevent unintentional bolus; infusion site for redness and inflammation; clinical and neurologic state, serum sodium level (and other electrolytes if possible); urine output: a sudden increase to more than 100 ml/hour may be an early sign of hyponatraemia overcorrection. Pregnancy and breast-feeding: administer only if clearly needed.
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500 ml bag, for IV infusion on central line or large peripheral vein, preferably using an infusion pump. DO NOT ADMINISTER BY IV, IM or SC INJECTION.
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Hypertonic solution of sodium chloride (3 g per 100 ml, 15 g in 500 ml) Ionic composition: + sodium (Na ) 513 mmol (513 mEq) per litre – chloride (Cl ) 513 mmol (513 mEq) per litre Osmolarity: 1027 mOsmol per litre
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Dosage varies according to patient’s underlying condition, severity of symptoms, clinical response and serum sodium level. For information: Severe symptomatic hyponatraemia Child under 50 kg: 3 ml/kg over 20 minutes Child 50 kg and over and adult: 150 ml over 20 minutes Check clinical response and serum sodium level. Repeat infusion up to 2 times if necessary during the first hour, until symptoms improve or serum sodium increases by 5 mmol/litre. Further correction of hyponatremia is based on serum sodium deficit calculation, to reach 130 mmol/litre. Do not increase serum sodium by more than 10 mmol/litre in the first 24 hours and 8 mmol/litre per 24 hours thereafter. Increased intracranial pressure in traumatic brain injury, cerebral oedema Child and adult: 3 ml/kg over 10 to 20 minutes Repeat infusion up to 2 times if necessary, according to clinical response.
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Do not use as a vehicle for administering injectable drugs, use 0.9% sodium chloride. 3% sodium chloride is not included in the WHO list of essential medicines.
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Below 25 °C
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3 ml/kg over 20 minutes
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150 ml over 20 minutes
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3 ml/kg over 10 to 20 minutes
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