Please check your internet connection and try again.
# Normal saline (0.9% Sodium Chloride)
## Overview
- Isotonic crystalloid solution (308 mOsm/L) containing 154 mEq/L sodium and chloride.
- Used for volume expansion, replacement of sodium/water deficits, and as a diluent for medications.
## Primary Indications
- Hypovolemia (hemorrhagic, dehydration, burns)
- Resuscitation in shock (unless hyperchloremic acidosis is a concern)
- Maintenance fluid when electrolyte-free water is not needed
- Flushing IV lines and wounds
## Adult Dosing
- **Resuscitation bolus**: 500 mL to 1 L over 15–30 minutes; may repeat based on response (local protocol dependent; e.g., 20 mL/kg ideal body weight in hemorrhagic shock)
- **Maintenance**: 1–2 mL/kg/hour (approximates 30–60 mL/hour for a 70 kg patient); adjust for insensible losses and ongoing deficits
- **Replacement**: match hourly losses (e.g., GI, renal) plus deficit
## Pediatric Dosing
- **Resuscitation bolus**: 10–20 mL/kg IV/IO over 5–20 minutes; may repeat up to 40–60 mL/kg (local protocol varies; monitor for fluid overload)
- **Maintenance**: based on Holliday-Segar method:
- First 10 kg: 4 mL/kg/hr
- Next 10 kg: 2 mL/kg/hr
- Each additional kg: 1 mL/kg/hr
- Maximum rate for resuscitation is patient- and protocol-dependent; avoid prolonged large volumes without balanced alternatives.
## Dose Adjustments
- **Renal impairment**: No dose adjustment for acute use; monitor volume status and electrolytes closely; avoid in severe oliguric renal failure unless correcting hyponatremia/hypovolemia.
- **Hepatic impairment**: No specific adjustment; caution with ascites/fluid overload.
- **Heart failure or edema**: Use lower rates and monitor for volume overload.
## Contraindications
- Hypernatremia (unless diluted with free water)
- Hyperchloremia or severe metabolic acidosis (relative)
- Hypervolemia (e.g., pulmonary edema, decompensated heart failure)
- Severe hypokalemia without potassium supplementation
## Adverse Effects
- Hypernatremia from large or rapid administration
- Hyperchloremic metabolic acidosis (especially high-volume resuscitation)
- Fluid overload (peripheral edema, pulmonary edema)
- Phlebitis (peripheral infusion)
- Electrolyte disturbances (hypokalemia, hypocalcemia if large volumes)
## Key Drug Interactions
- Lithium: reduced clearance; risk of lithium toxicity with decreased sodium
- Corticosteroids, NSAIDs, or vasopressin: increased sodium/fluid retention
- Antihypertensives: may reduce effectiveness of volume-dependent pressors
## Monitoring
- Serum electrolytes (sodium, chloride, potassium, bicarbonate)
- Fluid intake/output, daily weight
- Signs of fluid overload (jugular venous distention, edema, crackles)
- Acid-base status (especially during large-volume resuscitation)
## Clinical Pearls
- 0.9% saline is the most widely available crystalloid but its high chloride content (154 mEq/L) can cause hyperchloremic acidosis with large volumes; consider balanced solutions (e.g., Ringer’s lactate) for ongoing resuscitation.
- In diabetic ketoacidosis, initial bolus with saline is standard; switch to 0.45% saline once sodium normalizes.
- Do not administer through same line as certain drugs (e.g., amphotericin B, as diluent may cause precipitation); check compatibility.
- Use only if solution is clear, without visible particles; discard unused portion.
---
*Educational disclaimer: This information is for educational purposes only. Always verify current prescribing information, local protocols, and patient-specific factors before administering any drug.*
