Recommended Dosage of Sodium Chloride Tablets for Hyponatremia
The recommended dose of sodium chloride tablets for treating hyponatremia is 936 mg (4 ml of 23.4% solution) for adults aged 9-50 years, while children under 9 and adults over 50 should consult a physician for appropriate dosing. 1
Dosing Considerations Based on Patient Factors
- For adults aged 9-50 years, the standard dose is 4 ml of sodium chloride oral solution 23.4% (equivalent to 936 mg of sodium chloride), which provides 368 mg of sodium 1
- For children under 9 years and adults over 50 years, physician consultation is required to determine appropriate dosing 1
- In patients with severe symptomatic hyponatremia, oral sodium chloride tablets can be administered hourly in a dose calculated to deliver the equivalent of 0.5 ml/kg/h of 3% NaCl 2
- For patients with SIADH-related hyponatremia who don't respond to fluid restriction, sodium chloride 100 mEq orally three times daily may be added 3
Treatment Approach Based on Severity and Symptoms
- For severe symptomatic hyponatremia (mental status changes, seizures, coma), 3% hypertonic saline is preferred over oral tablets 3, 4
- For mild to moderate hyponatremia:
Monitoring and Safety Considerations
- Monitor serum sodium levels every 4 hours initially, then daily 3
- Limit correction rate to no more than 8 mmol/L in 24 hours to prevent osmotic demyelination syndrome 3, 4
- For patients with advanced liver disease, alcoholism, or malnutrition, use more cautious correction rates (4-6 mmol/L per day) 3
- Be prepared to administer hypotonic fluids if overcorrection occurs 5
Special Populations
- For patients with cirrhosis, hyponatremia is usually hypervolemic and may require albumin infusion along with sodium supplementation 3
- In elderly patients with SIAD-related hyponatremia, temporary use of NaCl tablets as an adjunct to fluid restriction can safely correct hyponatremia and reduce hospital stay 6
- For patients with heart failure and hyponatremia, sodium chloride tablets should be used cautiously due to potential fluid overload 3
Calculating Sodium Requirements
- Sodium deficit can be calculated using the formula: Desired increase in Na (mEq/L) × (0.5 × ideal body weight in kg) 3
- For hourly oral NaCl administration, calculate the dose to deliver the equivalent of 0.5 ml/kg/h of 3% NaCl with an objective of increasing serum sodium by 6 mEq/L 2
Common Pitfalls to Avoid
- Home preparation of sodium chloride supplements using table salt is not recommended due to potential errors in formulation 7
- Overly rapid correction of chronic hyponatremia (>8 mmol/L in 24 hours) can lead to osmotic demyelination syndrome 3, 4
- Inadequate monitoring during active correction can lead to complications 3
- Using sodium chloride tablets in cerebral salt wasting without adequate volume replacement can worsen outcomes 3