Massachusetts General Hospital

Department of Pharmacy
Department of Nursing
Critical Care

Generic Name: Sodium Chloride 3% (intravenous solution)

Synonyms: Hypertonic saline, NaCl 3%

Action: Increases serum Na + and osmolality to decrease intracranial pressure

Indications: Intracranial hypertension

Hepatic encephalopathy
Severe or chronic hyponatremia (i.e. Na+ <120mmol/L)
Cerebral salt wasting

Administration Guidelines.
Chronic hyponatremia: 30 – 100mL per hour for 12-24 hours based on
Usual Adult Dosage serum Na + deficit (see formula & precautions below)
Range and Route:
Intracranial Hypertension & Hepatic Encephalopathy: infusion rate
determined by sodium deficit (see formula below) & clinical
presentation

250-300mL bolus dose over 20 minutes can be used for emergent

control of increased intracranial pressure (central line required for
bolus). Consider 23.4% NaCl and mannitol in emergent situations.
3% (500mL bags supplied by pharmacy)
Standard
Concentration: • 3g NaCl/100mL (15g NaCl/500mL)
• 513mEq/L (~257mEq/500mL)
• 1027mOsm/L (~513mOsm/500mL)

EW Standard 3% (500mL bags supplied by pharmacy)

• Central line suggested
Special • Large bore vein required
considerations: • 3% inhalation solution available (potential med order error)
• Solution pH = 5
• To calculate sodium deficit:

Na + deficit = (Desired Na + conc. - Measured Na + conc.) X 0.6*(kg

body wt)
 (*Use 0.6 for men & children, 0.5 for women, 0.5 for geriatric men,
0.45 for geriatric women; body weight is ACTUAL body weight)

• To calculate infusion rate determined by sodium deficit:

3% NaCl infusion rate = sodium deficit/12.312 = mL/hour infusion

rate over 24 hours

1.2-2.4 mL/kg body weight/hr can raise serum Na + level by 1-

2mEq/L/hour

• Weaning infusion over 24 hours may decrease the risk of

rebound edema related to hyponatremia
• Check serum Na + (reference range: 135-145 mmol/L) and Osm
(reference range: 280-296 mosm/kg) Q6H.
• In crisis ICH situations, consider 23.4% NaCl administration

Massachusetts General Hospital

Department of Pharmacy

Department of Nursing

Critical Care

Generic Name: Sodium Chloride 23.4%

Trade Name: Hypertonic Saline

Action: Decreases intracranial pressure by enhancement of cerebral blood flow

across the blood brain barrier: augmentation of intravascular volume

Indications: Emergent reduction of increased intracranial pressure, intracranial

hypertension and cerebral edema during actively monitored ICPs.

Administration Guidelines:

Usual Adult Dosage and Range: 23.4 % NaCl ( 4mEq/ml) 30 mls delivered
IVP over 10-20 minutes via a controlled infusion device. Central line preferred
but not necessary.

Special Considerations:
  Restricted to the Neuro-Sciences Intensive Care Unit or in the presence of
an attending neurologist.
 Patient must have continuous ICP monitoring
 Infusion rate related hypotension has been observed if given over
suggested rate of infusion
 Dilution of vial not necessary.

Precautions and Side Effects:

 Hyperosmolarity, hypernatremia, hyperchloremia, hypokalemia

 Central pontine mylinolysis
 Congestive Heart Failure, hypotension, hypertension, fluid overload
 Pregnancy and lactation effect unknown
 Thrombophlebitis

References:

Qureshi, A, Suarez,J ( 2000) Use of hypertonic saline solutions in treatment of

cerebral edema and intracranial hypertension. Critical Care Medicine, Vol.
28,No9, pg. 3301-3313.

Suarez,J, Qureshi, A., et al ( 1998) Treatment of refractory intracranial

hypertension with 23.4% saline. Critical Care Medicine, Vol 26, No 6.pg. 1118-
1122.