How much na in normal saline

The risk of hemolysis increases as the tonicity decreases ; of the commercially available saline products, 0. Mixing hypotonic saline solutions with dextrose increases their tonicity and makes the overall solution approach isotonicity, making it feasible to administer an intravenous infusion with a lower sodium content.

For example, 0. Because hemolysis is accentuated by an increased ratio of hypotonic solution to blood and prolonged cell contact time with the solution, it has been suggested that administering hypotonic solutions at a slower rate or through a central line may decrease the risk of cell lysis; however, hemolysis can still occur with such precautionary measures and use of any hypotonic solution in patients should be used with extreme caution.

According to the manufacturer, it is not known whether sodium chloride can cause fetal harm or affect reproduction capacity; only administer sodium chloride during pregnancy if it is clearly needed. However, normal saline 0. Saline nasal preparations and topical solutions are safe for use during pregnancy. According to the manufacturer, it is not known whether sodium chloride is excreted in human milk.

Because 0. Use caution when using sodium chloride bacteriostatic injection, as the benzyl alcohol preservative is associated with the development of metabolic acidosis, kernicterus, and intraventricular hemorrhage in the neonatal population; bacteriostatic injection is contraindicated for direct use in the neonatal population. Consider the benefits of breast-feeding, the risk of potential infant drug exposure, and the risk of an untreated or inadequately treated condition. If a breast-feeding infant experiences an adverse effect related to a maternally ingested drug, healthcare providers are encouraged to report the adverse effect to the FDA.

Bacteriostatic sodium chloride products contain benzyl alcohol and are contraindicated in neonates and premature neonates. Gasping syndrome is characterized by central nervous depression, metabolic acidosis, and gasping respirations. If a sodium chloride solution is required for preparing medications or intravascular flush, only preservative-free injection should be used.

Many physiological changes occur during the first weeks of life that affect the neonate's handling of fluid and sodium, especially in premature neonates. Carefully assess fluid and sodium status and adjust therapy as appropriate. In general, volume expansion in neonates should only be used when clearly needed e. Premature neonates younger than 30 weeks gestational age should receive fluid resuscitation with 0.

Children, including neonates and infants, are at increased risk of developing hyponatremia and hyponatremic encephalopathy. Rapid correction of hypo- or hypernatremia requires an experienced clinician. Due to the risk of serious neurologic complications, dosage, rate, and duration of administration should be determined by a physician experienced in intravenous fluid therapy. Sodium chloride ophthalmic formulations i.

There are no data to determine if geriatric patients respond differently to sodium chloride compared to younger patients. However, sodium chloride is excreted by the kidney, and elderly patients are more likely to have decreased renal function. In general, dose selection for the elderly should be cautious and start at the low end of the dosing range, reflecting the greater frequency of decreased hepatic, renal, and cardiac function as well as concomitant disease or drug therapy.

Monitor renal function in the elderly when receiving sodium chloride. Azelastine; Fluticasone: Moderate Concomitant use of systemic sodium chloride, especially at high doses, and corticosteroids may result in sodium and fluid retention. Assess sodium chloride intake from all sources, including intake from sodium-containing intravenous fluids and antibiotic admixtures.

Carefully monitor sodium concentrations and fluid status if sodium-containing drugs and corticosteroids must be used together. Beclomethasone: Moderate Concomitant use of systemic sodium chloride, especially at high doses, and corticosteroids may result in sodium and fluid retention.

Benzalkonium Chloride: Major Sodium chloride saline solutions should not be used to dilute benzalkonium chloride as saline solutions may decrease the antibacterial potency of the antiseptic. Stored tap water should also not be used for dilution since it may contain microorganisms. Resin deionized water may also contain pathogens and it may inactivate benzalkonium chloride.

Betamethasone: Moderate Concomitant use of systemic sodium chloride, especially at high doses, and corticosteroids may result in sodium and fluid retention.

Budesonide: Moderate Concomitant use of systemic sodium chloride, especially at high doses, and corticosteroids may result in sodium and fluid retention. Budesonide; Formoterol: Moderate Concomitant use of systemic sodium chloride, especially at high doses, and corticosteroids may result in sodium and fluid retention.

Ciclesonide: Moderate Concomitant use of systemic sodium chloride, especially at high doses, and corticosteroids may result in sodium and fluid retention. Corticosteroids: Moderate Concomitant use of systemic sodium chloride, especially at high doses, and corticosteroids may result in sodium and fluid retention. Corticotropin, ACTH: Moderate Concomitant use of systemic sodium chloride, especially at high doses, and corticosteroids may result in sodium and fluid retention.

Cortisone: Moderate Concomitant use of systemic sodium chloride, especially at high doses, and corticosteroids may result in sodium and fluid retention. Deflazacort: Moderate Concomitant use of systemic sodium chloride, especially at high doses, and corticosteroids may result in sodium and fluid retention.

Dexamethasone: Moderate Concomitant use of systemic sodium chloride, especially at high doses, and corticosteroids may result in sodium and fluid retention. Fludrocortisone: Moderate Concomitant use of systemic sodium chloride, especially at high doses, and corticosteroids may result in sodium and fluid retention.

Flunisolide: Moderate Concomitant use of systemic sodium chloride, especially at high doses, and corticosteroids may result in sodium and fluid retention. Fluticasone: Moderate Concomitant use of systemic sodium chloride, especially at high doses, and corticosteroids may result in sodium and fluid retention. Fluticasone; Salmeterol: Moderate Concomitant use of systemic sodium chloride, especially at high doses, and corticosteroids may result in sodium and fluid retention. Fluticasone; Umeclidinium; Vilanterol: Moderate Concomitant use of systemic sodium chloride, especially at high doses, and corticosteroids may result in sodium and fluid retention.

Fluticasone; Vilanterol: Moderate Concomitant use of systemic sodium chloride, especially at high doses, and corticosteroids may result in sodium and fluid retention. Formoterol; Mometasone: Moderate Concomitant use of systemic sodium chloride, especially at high doses, and corticosteroids may result in sodium and fluid retention.

Hydrocortisone: Moderate Concomitant use of systemic sodium chloride, especially at high doses, and corticosteroids may result in sodium and fluid retention.

Lithium: Moderate Moderate to significant dietary sodium changes, or changes in sodium and fluid intake, may affect lithium excretion. Systemic sodium chloride administration may result in increased lithium excretion and therefore, decreased serum lithium concentrations. In addition, high fluid intake may increase lithium excretion. For patients receiving sodium-containing intravenous fluids, symptom control and lithium concentrations should be carefully monitored.

It is recommended that patients taking lithium maintain consistent dietary sodium consumption and adequate fluid intake during the initial stabilization period and throughout lithium treatment. Supplemental oral sodium and fluid should be only be administered under careful medical supervision. Methylprednisolone: Moderate Concomitant use of systemic sodium chloride, especially at high doses, and corticosteroids may result in sodium and fluid retention.

Mometasone: Moderate Concomitant use of systemic sodium chloride, especially at high doses, and corticosteroids may result in sodium and fluid retention. Prednisolone: Moderate Concomitant use of systemic sodium chloride, especially at high doses, and corticosteroids may result in sodium and fluid retention.

Prednisone: Moderate Concomitant use of systemic sodium chloride, especially at high doses, and corticosteroids may result in sodium and fluid retention. Tolvaptan: Moderate Coadministration of tolvaptan and hypertonic saline e. The use of hypertonic sodium chloride in combination with tolvaptan may result in a too rapid correction of hyponatremia and increase the risk of osmotic demyelination i. Triamcinolone: Moderate Concomitant use of systemic sodium chloride, especially at high doses, and corticosteroids may result in sodium and fluid retention.

Sodium is the principle cation of the extracellular fluid, while chloride is the principle anion. Both ions are physiologically important. Sodium functions as the primary osmotic determinant in extracellular fluid regulation and tissue hydration.

Additionally, sodium regulates the membrane potential of cells and the active transport of molecules across cell membranes. Chloride is also responsible for maintaining fluid balance, but it is also essential in the maintenance of acid-base balance. Low plasma chloride levels cause an increase in bicarbonate, producing alkalosis.

Sodium is a unique electrolyte because, in general, water balance is directly related to its concentration. High sodium concentrations and an increase is plasma osmolality stimulates mechanisms that increase the water content of the body, such as increased thirst and increased antidiuretic hormone ADH secretion, which leads to renal conservation of water.

During hyponatremia, the decrease in plasma osmolality stops ADH secretion; therefore, renal water excretion leads to an increase in sodium concentration. Although sodium and water balance is usually regulated by osmolality, volume depletion also stimulates thirst and ADH secretion; ADH secretion is triggered even if the patient is hyponatremic.

The initial goal of treating dehydration and shock is to restore intravascular volume, which improves perfusion to critical organs.

Hypotonic solutions should not be used for initial fluid resuscitation because a significant portion of the administered fluid distributes outside the intravascular compartment.

Hypotonic solutions are sometimes used in patients with high serum osmolarity e. In addition, hypotonic saline solutions offer a maintenance infusion option with less sodium content, which is desirable in certain patient populations. However, the most hypotonic fluid that can be safely administered without risking cell lysis is 0.

Normal saline NS is the commonly-used term for a solution of 0. Less commonly this solution is referred to as physiological saline or isotonic saline, neither of which is technically accurate.

NS is used frequently in intravenous drips IVs for patients who cannot take fluids orally and have developed or are in danger of developing dehydration or hypovolemia. NS is typically the first fluid used when hypovolemia is severe enough to threaten the adequacy of blood circulation and has long been believed to be the safest fluid to give quickly in large volumes. However, it is now known that rapid infusion of NS can cause metabolic acidosis [1].

NS is 9g NaCl dissolved in 1 liter water. The mass of 1 milliliter of NS is 1. Since NaCl dissociates into two ions - sodium and chloride - 1 molar NaCl is 2 osmolar. It has a slightly higher degree of osmolarity i. Half-normal saline 0. Quarter-normal saline 0. Hartmann's solution or Compound Sodium Lactate is a solution that is isotonic with blood and intended for intravenous administration. Phosphate buffered saline abbreviated PBS is a buffer solution commonly used in biological research.

It is a salty solution containing sodium chloride, sodium phosphate, and in some formulations potassium chloride and potassium phosphate.

The buffer helps to maintain a constant pH. Holliday and Segar decided on this number by looking at the sodium content of human and cows' milk. Click for flashback to chemistry.

When we speak about adding sodium to IV fluids, we talk about it in terms of normal saline. Normal saline is isotonic to plasma. Note that all of these are considered hypotonic to plasma. Based on current research, it is determined that giving hypotonic solutions as maintenance IV fluids is associated with severe morbidity and even mortality due to hyponatremia. We know that kids in the hospital are stressed. They are vomiting, or have respiratory illness, or require surgery, or have fever.

All of these things cause an increase in ADH release. The more ADH, the more water is reabsorbed from the collecting duct of the kidneys. Combine this with hypotonic IV fluids, and you have a perfect formula for hyponatremia.

This was estimated by Holliday and Segar to again reflect the composition of human and cow milk and has remained the same since then. In children who have a condition that might predispose to renal failure, such as dehydration, K is not added to intravenous fluids until the presence of renal function has been established. This means that there is 0. You can apply this conversion factor to any other amount.

There are two reasons for this:. Any solution that has less salt will be hypo-osmolar. Rapid infusion of a hypo-osmolar solution can cause osmotically induced water shift into the cells, and this can lead to detrimental effects such as hemolysis.

Ringer's lactate LR is a composite fluid that is available with and without dextrose. The lactate is metabolized in the liver to bicarbonate.

LR provides a source of base, as well as some Ca. M aintenance fluid calculations assume that fluid loss from sensible and insensible routes is taking place at a normal rate. But a febrile infant will be having a much greater transcutaneous evaporative water loss than one with a normal body temperature.

Similarly, a child with tachypnea will lose excess water from the lungs - unless she is receiving humidified oxygen, in which case she will lose none! Also consider patients with kidney disease who have anuria, oliguria, or polyuria. Maintenance IV fluids for these patients will not be written with the standard formula because their urinary losses are not taking place at a normal rate.

Maintenance fluids using the standard formula would be too much for an anuric child with no urinary losses and too little for those with a concentrating defect in their kidneys causing polyuria. Important : Before using a standard formula for calculating maintenance fluids, ensure that the child is not having higher or lower losses than usual! When we prescribe maintenance fluid for a 10 kg child for 24 hours as ml, we are assuming that loss from the various routes is occurring at a normal rate.

However, adjustments are sometimes necessary:. What is the hour fluid requirement for a 10 kg child who has a fever of 40 degrees C. Presuming the child is not receiving humidified O 2. What volume of maintenance fluid would you order for the next 12 hours for a 10 kg child with oliguria whose measured urine output in the previous 12 hours has been 50 ml?

I n children, the most common cause of dehydration is diarrheal fluid loss. This is known as isotonic dehydration. Electrolyte losses from diarrhea and vomiting range from iso- to hypo- osmolar. The tendency to have hypernatremia from loss of hypo-osmolar fluid is partially countered by movement of fluid from the ICF to the ECF driven by the increase in ECF osmolality.

This also helps maintain intra vascular volume. One potential scenario for hyponatremic dehydration is replacement of fluid loss by electrolyte-free water such as apple juice or iced tea, or with hypotonic fluids such as D5 0. Because of anti-diuretic hormone ADH secretion stimulated by hypovolemia, water will be retained even in the face of a falling serum sodium level.

For example, a child who is on gavage feeding with a fixed daily fluid intake and develops excessive fluid loss from tachypnea or fever will gradually develop hypernatremia. Hypernatremia is also seen in a small proportion of children with gastroenteritis and dehydration, presumably from excessive loss of water in relation to solute. C linical assessment of dehydration is always approximate, and the child should be frequently re-evaluated for continuing improvement during correction of dehydration.

If you have an accurate pre-illness weight, you may use that weight. Alternatively, the pre-illness weight can be calculated as follows:. The child's current dehydrated weight can be used for calculation of dehydration and maintenance fluids.

After all, clinical assessment of dehydration, and therefore the volume needed for correction, is approximate! T he initial goal of treating dehydration is to restore intravascular volume resuscitative phase.

The simplest approach is to replace dehydration losses with 0. This ensures that the administered fluid remains in the extracellular intravascular compartment, where it will do the most good to support blood pressure and peripheral perfusion.