| DRUG | SUPPLIED | DOSE | COMMENTS |
|---|---|---|---|
| SODIUM CHLORIDE 3% (Paeds) (Hypertonic Saline 3%, Mucoclear 3%) Mechanism of action: Sodium Chloride replacement, Hypertonic solution Ref: 341, 342, 343, 344, 345, 346, 347, 348, 542, 543, 544 Last update: 2022-09-11 |
ampoule for inhalation: 3% Sodium Chloride in 4 mL ampoule injection: 3% sodium chloride (0.513 mmol/mL) (250 mL) |
Hyponatremia Serum sodium <125 mmol/L and no symptoms: 1. Sodium (mmol) required to correct to target of 125 mmol/L = 0.6 x weight (kg) x (125 - current serum sodium). 2. Volume of sodium chloride 3% needed (mL) = sodium required (mmol) / 0.513 mmol Na/mL. 3. Administer sodium chloride 3% IV centrally at a maximum rate of 0.5 - 1 mmol/kg/hour (1 - 2 mL/kg/hour) or 100 mL/hour. Emergency correction of sodium when patient having symptoms (eg. seizures): Administer the calculated dose, up to a maximum of 6 mL/kg, IV over a period of 60 minutes. Critical Care Protocol for the Management of Severe Head Injuries: 1 - 2.5 mmol/kg/dose (2 - 5 mL/kg/dose) IV over 10 minutes. May repeat PRN. Aim to maintain serum sodium less than 160 mmol/L. Bronchiolitis: 4 mL inhaled via nebulizer Q8H. |
If serum sodium is less than 140 mmol/L, 3% NaCl should be used for management of increased ICP. If serum sodium is greater than 140 mmol/L, 3% NaCl or mannitol could be considered for management. Evidence suggest 3% NaCl may be the preferred treatment for increased ICP due to multisystem trauma and cerebral edema from DKA. 3% sodium chloride 5 mL/kg is the equivalent dose of 20% mannitol 1 gram/kg. Nebulized hypertonic saline no longer recommended for bronchiolitis as studies have shown it is ineffective. Bronchospasm is a rare adverse effect of hypertonic saline when used for bronchiolitis. Do not use injection for nebulization. Standard Prescription: Inhalation: hypertonic saline 3% ____mL by inhalation Q__H Intravenous: hypertonic saline 3% ____ml/kg IV over ___ mins |