Key points
- We recommend to consult your poison centre with the use of this antidote.
- Use only in the event of a shortage of sodium bicarbonate for cases of poisoning caused by sodium channel blockers.
- 1 g of sodium chloride = 393.3 mg of elemental sodium = 17.1 mEq = 17.1 mmol.
- 1 ml/kg of 3% NaCl will increase blood sodium levels by approximately 1 mEq/L.
+ Synonyms and other terms
- 3% NaCl
- Hypertonic sodium chloride
- Sodium chloride
- Concentrated saline solution
+ Indications
Use only in the event of a shortage of sodium bicarbonate:
- Cardiotoxicity involving QRS with right ventricular delay, hypotension or ventricular arrhythmia caused by sodium channel blockers, such as tricyclic antidepressants, antiarrhythmic drugs (class “Ia” or “Ic,” etc.).
Since 3% NaCl does not metabolize into bicarbonates, it is not indicated in the following cases (sodium acetate is then the preferred option):
- Blood alkalinization to reduce the distribution of salicylates in the CNS.
- Urinary alkalinization due to salicylate poisoning.
- Correction of metabolic acidosis caused by methanol or ethylene glycol poisoning or secondary to lactic acidosis.
+ Dosage
+ Pediatric Dose
Cardiotoxicity: 2 ml/kg (or 1 mEq/kg) by direct IV (maximum 150 ml).
+ Adult Dose
Cardiotoxicity: 2 ml/kg (or 1 mEq/kg) by direct IV (maximum 150 ml).
+ Renal Impairment
Watch out for fluid overdose (high sodium levels).
+ Hepatic Impairment
No data suggests that the dose should be modified for short-term use.
+ Hemodialysis Patient
No data suggests that the dose should be modified for short-term use.
+ Pregnancy
- The safety of large doses of hypertonic sodium chloride has not be demonstrated.
- Do not hesitate to use during pregnancy if the anticipated toxic effects pose a significant risk of morbidity or mortality.
- No data suggests that the dose should be modified for short-term use.
+ Obese or Overweight Patient
No data suggests that the dose should be modified for short-term use.
+ Adverse effects
- Hypernatremia (elevate sodium level), fluid overload.
+ Monitoring
- Vital signs
- Serum electrolytes
+ End of treatment
- Cardiotoxicity: When QRS is below 100 milliseconds or when blood pressure is stabilized and arrhythmias are corrected.
+ Special Notes on Administration
Intravenous Route (IV)
- Direct IV:
- Administer using a volumetric pump or syringe pump.
- For concentrated saline solution, administer by a main peripheral vein or ideally by central venous line.
- Administer over 15 to 20 min at a maximum rate of 1 mmol/kg.
Subcutaneous Route (SC)
- Do not administer by this route.
Intramuscular Route (IM)
- Do not administer by this route.
Intraosseous Route (IO)
- Do not administer by this route.
Compatibility
Partial list only. Consult the pharmacist on duty at your health care facility.
- Compatible solutions: No data available.
- Y-site compatibility: No data available.
- Y-site incompatibility: No data available.
Stability
- Store unopened solute bags at room temperature (20°C-25°C).
- Discard all unused solution.
+ Available products
- 3% sodium chloride solution for injection, 250 ml solute (Viaflex), Baxter Canada, catalogue number JB1352.
- NaCl content: 3 g/100 ml; 30 mg/ml; 513 mmol/L; 0.513 mmol/ml.
- Osmolarity: 1030 mOsm/L; 1 mOsm/ml.
+ Amount required to treat a person weighting 70kg during 24 hours
- No specific recommendation at this time.
+ References
(Section en développement)
© Centre antipoison du Québec, CIUSSS de la Capitale-Nationale, 2017. The information contained in this site may be cited, provided the source is acknowledged. Any use for commercial or advertising purposes is strictly prohibited.
