Hypertonic Sodium Chloride (NaCI) (3%)

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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.

3% Hypertonic Sodium Chloride (NaCl)

  • Note: A discussion with a consultant must occur before therapy with 3% Hypertonic Sodium Chloride is initiated.

Indication

  • An electrolyte supplement
  • 3% Hypertonic NaCl should only be used for Emergency treatment of severe hyponatremia
  • Expansion of the extracellular fluid compartment in cases of hypovolemia and low blood pressure should be done with 0.9% NaCl (normal saline.)

Pharmacology

Concentration

mmol/L Na

Osmolarity
(mosm/L)

0.9% NaCl
("Isotonic", "Normal Saline")

154

310

3% Hypertonic NaCl

513

1,025

Side Effects

  • Sodium toxicity is almost always related to how fast a sodium deficit is corrected.
  • Hypernatremia, edema
  • Too rapid an administration may result in an increase in serum osmolality, resulting in CNS hemorrhage.

Precautions

  • administer slowly (see below under "Replacement of Deficit Dose")
  • 3% Hypertonic NaCl must be diluted before administration, or 'Y'd" with another IV solution
  • the oral solution should always be diluted, mixed with oral feeds

Dose

  • Replacement of Deficit Dose: mmol Na needed = [Desired Serum Na (mmol/L) - Actual Serum Na (mmol/L)] x Weight (kg) x 0.6
  • Maximum Rate: 1 mmol/kg/h (the slower the rate the better to minimize sudden alterations in serum osmolality)
  • Maintenance Requirements: 
    • Preterm: 2 - 8 mmol/kg/d
    • Term: 3 - 4 mmol/kg/d

Supplied As

  • 3% Hypertonic NaCl (0.5 mmol / mL): 115 mL IV bags for IV use (must be diluted or "Y"d with another IV solution)
  • Amber bottles for oral use (dilute or mix with oral feeds)
References
  1. Pediatric Dosage Handbook,11th Edition, Taketomo CK, Hodding JH, Jraus DM (Editors), Lexicomp, APHA, Hudson, Ohio
  2. Neonatal Medications and Nutrition, 3rd Edition, Zenk KE, Sills JH, Koeppel RM, NICU Link, Santa Rosa, California
  3. Neonatal and Pediatric Pharmacology, 3rd Edition, Yaffe SJ, Aranda JV (Editors), Lippincott Williams and Wilkins, New York