sodium chloride: clinical use

Prescribing considerations

• Confirm the indication and formulation; oral replacement, intravenous fluid therapy, diluent use and irrigation have different risk profiles.
• Account for sodium from diet, other medicines, feeds and all intravenous fluids, particularly in sodium-restricted patients.
• Use extra caution in infants, older people, renal impairment, cardiac or pulmonary failure, liver disease, hypertension, oedema, pre-eclampsia and states of altered vasopressin secretion.
• Avoid rapid correction of chronic sodium disturbances because serious neurological injury can result.
• When used as a diluent, assess the additive's compatibility, route, contraindications and pregnancy or breastfeeding information separately.

Contraindications and cautions

• Selected injection products are contraindicated in hypernatraemia or hyperchloraemia; an infusion product also lists hyperhydration and severe hypernatraemia or hyperchloraemia.
• Oral products should not be used where sodium retention is undesirable, including oedema, cardiac decompensation and primary or secondary aldosteronism, or during treatment intended to produce salt and water loss.
• The selected eye-irrigation product lists no contraindications; check the current product-specific SmPC.

Monitoring

• Assess clinical fluid status, input and output, serum electrolytes, renal function and acid-base balance when systemic replacement warrants it.
• Monitor cardiovascular and respiratory status when substantial or rapid intravenous fluid administration is clinically necessary.
• Increase monitoring in children, older adults, renal impairment and patients taking medicines that affect vasopressin, sodium or water balance.
• Observe infusion sites and stop administration if a significant reaction or complication develops.

Clinical pharmacology

Sodium and chloride distribute mainly in extracellular fluid and determine much of its osmotic pressure. Sodium is primarily eliminated by the kidneys after extensive tubular reabsorption; smaller amounts are lost through sweat and faeces.

Formulation and product differences

• Prolonged-release tablets provide oral sodium chloride replacement and must be swallowed whole.
• The concentrated oral solution is measured with the supplied device and can be diluted before administration.
• Sterile isotonic injection and infusion solutions are used systemically, as compatible carriers, or for specified irrigation and procedural uses.
• The preservative-free eye preparation is a sterile single-use isotonic irrigating solution and must be discarded after opening.

Solution for infusion

Route: Intravenous

Strengths: 0.45%, 0.9%, 0.9% w/v, 30% w/v

Eye drops

Route: Ophthalmic

Strengths: 0.9% w/v