How to administer 3% (three percent) Sodium Chloride (NaCl) solution?

Administration of 3% Sodium Chloride (NaCl) Solution

For severe symptomatic hyponatremia, administer 3% hypertonic saline as boluses of 100 mL over 10 minutes, which can be repeated up to three times at 10-minute intervals until symptoms improve. 1

Indications for 3% NaCl

• 3% hypertonic saline is primarily indicated for severe symptomatic hyponatremia with neurological symptoms such as confusion, seizures, or coma 1, 2
• It is also used in neurosurgical patients with cerebral salt wasting when combined with appropriate volume replacement 2
• 3% NaCl may be used in cases of increased intracranial pressure requiring hyperosmolar therapy 3

Administration Guidelines

For Severe Symptomatic Hyponatremia:

• Initial bolus therapy: Administer 100 mL of 3% NaCl over 10 minutes 1, 4
  • Can be repeated up to three times at 10-minute intervals if symptoms persist 1
  • A 250 mL bolus may be more effective than 100 mL for achieving target sodium increase (≥5 mmol/L within 4 hours) 4
• Alternative approach: Continuous infusion of 500 mL of 3% NaCl over 6 hours through a peripheral vein 5

Administration Route:

• 3% NaCl can be safely administered through either a peripheral IV or central venous catheter 3
• No reported local infusion reactions were found with 3% NaCl in a large healthcare system over a 10-year period 3

Monitoring and Safety Parameters

• Target correction rate: Increase serum sodium by 4-6 mmol/L in the first 6 hours or until severe symptoms resolve 2
• Maximum correction limits:
  • Do not exceed 8 mmol/L in 24 hours for most patients 2
  • For high-risk patients (advanced liver disease, alcoholism, malnutrition): limit to 4-6 mmol/L per day 2
• Monitor serum sodium every 2 hours during initial correction for severe symptoms 2
• Watch for signs of osmotic demyelination syndrome (dysarthria, dysphagia, oculomotor dysfunction, quadriparesis) 2

Special Considerations

• Patients with heart failure and volume overload require caution when receiving 3% NaCl 2
• In neurosurgical patients, distinguish between SIADH and cerebral salt wasting, as treatment approaches differ significantly 2
• For patients with mild symptoms or asymptomatic hyponatremia, oral hypertonic solutions may be considered instead of IV 3% NaCl 1

Common Pitfalls to Avoid

• Overly rapid correction exceeding 8 mmol/L in 24 hours can lead to osmotic demyelination syndrome 2
• Inadequate monitoring during active correction 2
• Using fluid restriction in cerebral salt wasting can worsen outcomes 2
• Failing to recognize and treat the underlying cause of hyponatremia 2
• Using hypertonic saline in hypervolemic hyponatremia without life-threatening symptoms 2

By following these guidelines, 3% sodium chloride can be administered safely and effectively to correct severe hyponatremia while minimizing the risk of complications.