From the Guidelines
0.9% sodium chloride is indicated for fluid resuscitation, correction of hypovolemia, and treatment of mild to moderate sodium deficiency, but its use should be limited to a maximum of 1–1.5 L in trauma patients, as balanced electrolyte solutions may be advantageous 1.
Indications for 0.9% Sodium Chloride
- Fluid resuscitation
- Correction of hypovolemia
- Treatment of mild to moderate sodium deficiency
- Vehicle for medication administration
Usage Considerations
- Typically administered intravenously over 1-8 hours, adjusted according to clinical response and laboratory values
- Standard dosage varies based on patient needs, but typically ranges from 500-1000mL
- For maintenance fluid therapy in adults, 1.5-2.5 liters per day is common, while pediatric dosing follows weight-based calculations
- Contains 154 mEq/L of both sodium and chloride, making it isotonic with blood plasma
- Large volume administration can potentially cause hyperchloremic metabolic acidosis due to its relatively high chloride content compared to plasma, so monitoring is important in high-volume or prolonged use
Special Considerations in Trauma Patients
- Balanced electrolyte solutions may be advantageous due to their physiological or near-physiological concentrations of chloride 1
- Use of 0.9% sodium chloride should be limited to a maximum of 1–1.5 L in trauma patients 1
- Saline solutions should not be used in severe acidosis, especially when associated with hyperchloremia 1
From the FDA Drug Label
INDICATIONS AND USAGE: Sodium Chloride Injection, USP, 23. 4%, is indicated as an additive in parenteral fluid therapy for use in patients who have special problems of sodium electrolyte intake or excretion. It is intended to meet the specific requirements of the patient with unusual fluid and electrolyte needs Sodium Chloride Injection is indicated for the treatment of sodium, chloride and water deficiencies that commonly occur in many diseases Isotonic Sodium Chloride Injection should be limited to cases in which the chloride loss is greater than the sodium loss, as in vomiting from pyloric obstruction, or in which the loss is about equal, as in vomiting from duodenal, jejunal or ileal obstruction and in the replacement of aspirated gastrointestinal fluids Other disorders in which sodium chloride is therapeutically useful include extensive burns, failure of gastric secretion and postoperative intestinal paralysis.
The indication for 0.9% sodium chloride is not explicitly stated in the provided text, which refers to 23.4% sodium chloride. However, based on the information provided for sodium chloride in general, the indications can be summarized as:
- Treatment of sodium, chloride, and water deficiencies
- Replacement of lost fluids and electrolytes in cases such as:
- Vomiting from pyloric obstruction
- Vomiting from duodenal, jejunal, or ileal obstruction
- Replacement of aspirated gastrointestinal fluids
- Therapeutic use in:
- Extensive burns
- Failure of gastric secretion
- Postoperative intestinal paralysis Since the provided text does not directly address 0.9% sodium chloride, no specific conclusion can be drawn for this concentration 2.
From the Research
Indications for 0.9% Sodium Chloride
- 0.9% sodium chloride, also known as normal saline, is commonly used for fluid resuscitation in various medical conditions.
- According to a study published in Critical Care Medicine 3, 0.9% saline was used as a fluid bolus for initial fluid resuscitation in patients with sepsis-induced hypotension.
- Another study published in The Journal of Trauma 4 compared the effects of lactated Ringer's solution and normal saline on coagulation in an uncontrolled hemorrhagic shock swine model, indicating that normal saline can be used in such scenarios.
- However, it is essential to note that the use of 0.9% sodium chloride may be associated with higher levels of serum chloride and decreased levels of serum bicarbonate, as observed in the study by 3.
- The other studies provided do not directly address the indications for 0.9% sodium chloride, as they focus on different topics such as the treatment of uncomplicated urogenital gonorrhoea 5, prevention of exacerbations of COPD with an eosinophilic phenotype 6, and atrial fibrillation in critical illness 7.
Clinical Use
- The choice of fluid for resuscitation depends on various factors, including the patient's condition, the type of shock, and the presence of any electrolyte imbalances.
- In general, 0.9% sodium chloride is considered a safe and effective choice for fluid resuscitation in many clinical situations, including sepsis-induced hypotension and uncontrolled hemorrhagic shock.
- However, it is crucial to consider the potential effects of 0.9% sodium chloride on serum electrolyte levels and to monitor patients closely during fluid resuscitation.