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.
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.