sodium chloride


T. O. Chemicals


T. O. Chemicals
Full Prescribing Info
Sodium chloride.
Each 100 mL contains sodium chloride 900 mg.
Pharmacology: Pharmacodynamics: NSS T.O. which provides combinations of isotonic concentrations of sodium chloride is suitable for parenteral maintenance or replacement of water and electrolyte requirements.
Sodium is the major cation (positive ion) of the extracellular fluid, factions primarily in the control of water distribution, fluid balance, and osmotic pressure of body fluids. Sodium is also associated with chloride and bicarbonate in the regulation of the acid base equilibrium of body fluid.
Chloride is the major extracellular anion (negative ion), closely follows the metabolism of sodium, and changes in the acid-base balance of the body are reflected by changes in the chloride concentration.
Pharmacokinetics: Water balance is maintained by varuous regulatory mechanisms. Water distribution depends primarily on the concentration of electrolytes in the body compartments and sodium (Na+) plays a major role in maintaining physiologic equilibrium. Sodium chloride is an electrolyte replenisher. Sodium is the principal cation of extracellular fluid. With a normal plasma concentration of 142 mEq/L, sodium comprises more than 90% of the total plasma cations. While sodium can diffuse across membranes, the intracellular sodium is maintained at a maintained at a much lower level than extracellular concentrations, the so-called "sodium pump". Compensation for loss of intracellular potassium occurs through an increase in intracellular sodium. Sodium is the principal ion that determines osmotic pressure of interstitial fluids and the degree of tissue hydration.
Adult serum chloride values typically range from 100 to 106 mEq/L. Serum chloride levels decrease in metabolic alkalosis, as serum bicarbonate levels generally increase. In parenteral nutrition when acidosis occurs, it is common practice to reduce chloride intake by substituting acetate salts in place of chloride salts.
Sodium chloride intravenous solutions are indicated for diluting or dissolving drugs for intramuscular (IM), intravenous (IV) or subcutaneous injection or follow the doctor's order.
Dosage/Direction for Use
General dosing considerations: Dosage is to be directed by a physician and is dependent on age, weight, clinical condition of the patient, and laboratory determinations, Frequent laboratory determinations and clinical evaluation are essential to monitor changes in blood glucose and electrolyte concentrations, and fluid and electrolyte balance during prolonged parenteral therapy.
Fluid administration should be based on calculated maintenance or replacement fluid requirements for each patient.
Parenteral replenishment of fluid and sodium chloride: The dose is dependent upon the age, weight, and clinical condition of the patient.
MODE OF ADMINISTRATION: Route of administration: For intravenous administration, or as appropriate to the reconstituted drug. The method of administration and volume for dissolving the drugs to be injected will depend on the particular medicine being prepared, or on the irrigation procedures being used. The rate of injection is dependent on the age, weight, clinical status and degree of deficiency, and must be determined on an individual basis.
Administration of large doses may give rise to sodium accumulation, oedema, and hyperchloraemic acidosis.
Excess chloride in the body may cause a loss of bicarbonate, with an acidifying effect.
Treatment: Diuretics may be used to treat oedema resulting from isotonic expansion, and appropriate replacement therapy should be employed to avoid fluid and electrolyte imbalance. Treatment of hypervolaemic hypernatraemia requires removal of sodium in excess of water and can be achieved by replacing diuretic-induced sodium and water losses with only water. The basic aim of therapy is to restore the volume and composition of the body fluids to normal.
Hypernatremic and fluid retention syndromes. Elevated, normal, or only slightly decreased plasma electrolyte concentrations, or when additives of sodium and chloride could be clinically detrimental.
Special Precautions
The risk of solute overload causing congested state with peripheral and pulmonary edema is directly proportional to the electrolyte concentration of such solutions. Excessive amounts of sodium chloride by any route may cause hypokalemia and acidosis. Excessive amounts by the parenteral route may precipitate congestive heart failure and acute pulmonary edema, especially in patients with cardiovascular disease and in patients receiving corticosteroids or corticotropin or drugs that may give rise to sodium retention. Excessive infusion of hypertonic sodium chloride may supply more sodium and chloride than normally found in serum and can exceed normal tolerance, resulting in hypernatremia. Infusion of excess chloride ions may cause a loss of bicarbonate, resulting in an acidifying effect.
The intravenous administration of this solution can cause fluid or solute overloading resulting in dilution of other serum electrolyte concentrations, over hydration, congested states or pulmonary edema.
Sodium Chloride 0.9% w/v Solution for Injection should be administered with caution to patients with congestive cardiac failure, pre-eclampsia hypertension, peripheral and pulmonary oedema and impaired renal function. Sodium retention may occurs in patients with congestive cardiac failure, severe renal insufficiency, and in clinical states in which there exists edema with sodium retention.
Care is also required when administering this solution to very young or to the elderly patients. For use in newborns, only preservative-free sodium chloride 0.9% injection should be used.
Extraodinary electrolyte losses may occur during proteacted nasogastric suction, vomiting, diarrhea, or gastrointestinal fistula drainage and may necessitate additional electrolyte supplementation. Additional essential electrolytes, minerals, and vitamins should be supplied as needed.
Pseudohyponatraemia is a condition in which spuriously low concentrations of sodium are found when plasma sodium is measured by conventional methods. It may occur when there is an abnormally high concentration of large molecules and hence an abnormally low percentage of plasma water. This may occur in hyperlipaemia and hyperproteinaemia and has also been reported in patients with diabetes mellitus. Correct values may be obtained by referring the concentration to plasma water.
Surgical patients should seldom receive salt-containing solutions immediately following surgery unless factors producing salt depletion are present. Because renal retention of salt occurs during surgery, additional electrolytes given intravenously may result in fluid retention, edema and circulatory overload.
Before use, ensure that the container is undamaged and the contents clear in appearance. After use, discard any remaining solution.
Use In Pregnancy & Lactation
Pregnancy: Category C. Animal reproduction studies have not been conducted. Sodium requirements do not change during pregnancy. Nasal saline rinses may be used for the treatment of pregnancy rhinitis.
Labor and delivery:
The effects of NSS T.O. on labor and delivery in pregnant woman are unknown.
Lactation: Sodium is found in breast milk. Sodium requirements do not change during breast-feeding.
Adverse Reactions
Reaction due to solution or technique of administration: Reactions which may occur because of the solution or the technique of administration include febrile response, infection at the site of injection, venous thrombosis or phlebitis extending from the site of injection, extravasation and hypervolemia.
Injudicious intravenous saline therapy (e.g. post-operatively and in patients with impaired cardiac or renal function) may cause hypernatraemia. Hypernatraemia may be associated with edema and exacerbation of congestive heart failure due to the retention of water, resulting in an expanded extracellular fluid volume. Osmotically induced water shifts decrease intracellular volume, resulting in dehydration of internal organs, especially the brain, which may lead to thrombosis and haemorrhage.
General adverse effects of sodium chloride excess in the body include nausea, vomiting, diarrhoea, abdominal cramps, thirst, reduced salivary and lachrymal secretions, sweating, fever, hypotension, tachycardia, renal failure, peripheral and pulmonary oedema, respiratory arrest, headache, dizziness, restlessness, irritability, weakness, muscular twitching and rigidity, convulsions, coma and death. Excess chloride in the body may cause a loss of bicarbonate, with an acidifying effect.
If administered sub-cutaneously, any addition to the isotonic solution could render it hypertonic and cause pain at the site of injection.
Too rapid infusion: Too rapid infusion of hypotonic solutions may cause local pain and venous irritation. Rate of administration should be adjusted according to tolerance. Use the largest peripheral vein and a well placed small bore needle is recommended.
Discontinuation: If an adverse reaction dose occurs, discontinue the infusion, evaluate the patient, institute appropriate therapeutic countermeasures, and save the reminder of the fluid of examination if deemed necessary.
Drug Interactions
Corticosteroids and corticotrophin: Caution must be exercised in the administration of parenteral fluids, especially those containing sodium ions to patients receiving corticosteroids or corticotropin.
Concomitant administration of other sodium salts may contribute to the sodium load. Only use as a pharmaceutical diluent where indicated in the manufacturer's literature.
Do not store above 30°C.
ATC Classification
B05CB01 - sodium chloride ; Belongs to the class of salt solutions used as irrigating solutions.
Inj (amp) 0.9% (clear and colorless solution) x 5 mL x 25's x 4's, 10 mL x 25 x 4's.
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