Recommended Infusion Rate for 3% Sodium Chloride
For severe symptomatic hyponatremia, 3% sodium chloride should be administered at a rate of 1-2 mmol/L per hour until symptoms abate, with a maximum correction of 12 mmol/L in 24 hours or 18 mmol/L in 48 hours. 1
Adult Infusion Rates
Severe Symptomatic Hyponatremia
- Initial bolus: 100-150 mL of 3% sodium chloride over 10-20 minutes for patients with severe neurological symptoms 2
- Continuous infusion: Calculate using formula: body weight (kg) × desired rate of increase in sodium (mmol/L per hour) 1
- Target rate of correction: 1-2 mmol/L per hour until symptoms improve 1
- Maximum correction limits: 6 mmol/L in 6 hours, 12 mmol/L in 24 hours, or 18 mmol/L in 48 hours 3
Mild to Moderate Hyponatremia
- For less severe symptoms: 0.5 ml/kg/h of 3% sodium chloride 4
- Peripheral administration is safe at rates up to 999 mL/h in emergency situations 5
Monitoring Requirements
- Measure serum sodium every 2-4 hours during active correction 3
- Monitor for neurological status changes throughout treatment 3
- Calculate corrected serum sodium for hyperglycemia (add 1.6 mEq to sodium value for each 100 mg/dL glucose >100 mg/dL) 3
- Monitor serum osmolality to ensure changes do not exceed 3 mOsm/kg/h 3
Safety Considerations
- Avoid correction exceeding 12 mmol/L in 24 hours to prevent osmotic demyelination syndrome 1
- Be prepared to administer hypotonic fluids (e.g., D5W) if overcorrection occurs 2
- Ensure renal function is adequate before adding potassium to infusions 3
- Peripheral administration of 3% sodium chloride is safe even at rapid rates (≥250 mL/h) in emergency situations 5
Special Populations
- Pediatric patients: Use more conservative initial rates (10-20 mL/kg/h) with careful monitoring 3
- Patients with cardiac or renal compromise: Require more frequent monitoring of serum osmolality and mental status 3
Practical Administration Tips
- 3% sodium chloride can be safely administered through peripheral IV lines 5
- In emergencies when IV access is limited, hourly oral sodium chloride tablets may be considered as an alternative to IV 3% sodium chloride 4
- A 500 mL continuous infusion of 3% sodium chloride over 6 hours has been shown to be effective and safe for hyponatremic encephalopathy 6
Following these guidelines for 3% sodium chloride administration ensures effective treatment while minimizing the risk of complications from either under-correction or over-correction of serum sodium levels.