Sodium Chloride

Sodium chloride is the principal extracellular electrolyte salt, used clinically as an intravenous crystalloid (most commonly 0.9% "normal saline"), oral or parenteral electrolyte replacement, hypertonic solution for symptomatic hyponatremia, nebulized irrigant in cystic fibrosis and bronchiectasis, ophthalmic decongestant, and pharmaceutical diluent^[1]. Normal saline (154 mEq/L Na+ and 154 mEq/L Cl-) is the most widely administered medicinal product in the world.

Crystalloid IV fluid, Electrolyte replacement

Sodium chloride

Normal saline, NaCl injection, many; nebulized: HyperSal, PulmoSal

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Summary

Classes

Crystalloid IV fluid, Electrolyte replacement

Common uses

Volume resuscitation0, Maintenance IV fluid0, Hyponatremia (3% hypertonic for symptomatic)0, Nebulized 3-7% for cystic fibrosis airway clearance0, IV medicine diluent0

Pharmacy

Starting dose

Volume and concentration titrated to clinical status; symptomatic hyponatremia: 3% NaCl 100-150 mL bolus, reassess

Preparations

0.225%, 0.45%, 0.9%, 3%, 5% IV solutions; 0.9% nasal spray; 3% and 7% nebulizer solutions; oral tablets (1 g)

US FDA Max

No fixed maximum; titrated; sodium correction rate in chronic hyponatremia must not exceed 8-10 mEq/L per 24 hours to avoid osmotic demyelination

Pharmacology

Routes

IV, oral, nebulized, intranasal, ophthalmic

Onset

Immediate (IV)

Duration

Roughly 20-25% of an IV bolus remains intravascular at 1 hour

Half-life

Not applicable (electrolyte)

Bioavailability

100% (IV); essentially complete (oral)

Pregnancy

Standard fluid and electrolyte management

Legal status

Rx-only for parenteral formulations; OTC for oral, nasal, and many nebulizer products

Purported mechanism

Sodium chloride solutions expand the extracellular volume in proportion to their tonicity; high-volume 0.9% saline reliably produces hyperchloremic metabolic acidosis, which is why balanced crystalloids like Lactated Ringer's are often preferred for large-volume resuscitation.0 Hypertonic 3% is the standard urgent treatment of severely symptomatic hyponatremia^[1].

References

↑ ^1.0 ^1.1 FDA Prescribing Information, 0.9% Sodium Chloride Injection, Baxter, current revision. https://www.accessdata.fda.gov/drugsatfda_docs/label/2018/018324s039lbl.pdf

[nacl-label-1] 1.0 ^1.1 FDA Prescribing Information, 0.9% Sodium Chloride Injection, Baxter, current revision. https://www.accessdata.fda.gov/drugsatfda_docs/label/2018/018324s039lbl.pdf

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