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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.
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].
