23.4% w/v SODIUM CHLORIDE INJECTION USP Infusion/Solution for

What is 23.4% w/v SODIUM CHLORIDE INJECTION USP

23.4% Sodium Chloride Injection USP is a highly concentrated, sterile solution of sodium chloride (NaCl) in water for injection. It is intended for intravenous administration in a controlled hospital setting, typically as an adjunctive agent for the management of severe sodium deficits (hyponatremia), fluid imbalances, or as a component of parenteral nutrition or specialized electrolyte formulations. This solution contains 234 mg of sodium chloride per mL, equating to 4 mEq of sodium and chloride per mL.

• Concentration: 23.4% w/v (weight/volume), making it a hypertonic solution.
• Form: Infusion/Solution for Injection.
• Packaging: 50 ml Polyethylene Bag.
• Active Ingredient: Sodium Chloride – a critical electrolyte involved in maintaining osmotic pressure, fluid balance, and nerve conduction.

This preparation is not intended for direct infusion without prior dilution and must be used under strict medical supervision due to the risks of hypernatremia and vascular irritation.

How to use 23.4% w/v SODIUM CHLORIDE INJECTION USP

Due to its hypertonic nature, 23.4% Sodium Chloride Injection must be used with great caution. The solution is primarily used as a concentrated source of sodium in large-volume parenteral solutions or for correcting acute hyponatremia in critically ill patients.

• Administration Route: Intravenous (IV) only, after proper dilution.
• Dilution Requirement: Must be diluted before administration; never use undiluted due to the risk of serious vascular damage.
• Infusion Method: Typically added to compatible IV fluids such as Dextrose or normal saline under sterile conditions.
• Monitoring: Continuous monitoring of serum sodium levels, fluid balance, and overall electrolyte status is essential during administration.
• Professional Oversight: Only trained healthcare providers should handle and administer this product.

The infusion rate and final volume should be determined based on the patient’s individual electrolyte requirements and clinical condition.

Mode of Action 23.4% w/v SODIUM CHLORIDE INJECTION USP

The therapeutic effect of 23.4% Sodium Chloride Injection is primarily due to its hypertonic sodium content, which directly influences plasma osmolality and fluid distribution within the body.

• Osmotic Effect: The high concentration of sodium exerts an osmotic force that draws water out of intracellular spaces into the extracellular compartment, thereby expanding plasma volume.
• Electrolyte Repletion: Provides a rapid and concentrated source of sodium and chloride ions, essential for cellular function, electrical conduction in nerves and muscles, and maintenance of acid-base balance.
• Correction of Hyponatremia: Used in critical care to manage acute symptomatic hyponatremia, particularly when water restriction alone is insufficient.
• Vascular Support: Increases intravascular volume in hypovolemic states when used as part of larger fluid therapy protocols.

By influencing fluid distribution and correcting electrolyte imbalances, it stabilizes vital cellular processes and supports cardiovascular and neurological functions.

23.4% w/v SODIUM CHLORIDE INJECTION USP Interactions 23.4% w/v SODIUM CHLORIDE INJECTION USP

Although 23.4% Sodium Chloride Injection is a simple electrolyte solution, it may interact with other drugs, especially those affecting fluid and electrolyte balance.

• Diuretics: Use with potassium-wasting diuretics (e.g., furosemide) may exacerbate electrolyte imbalances. Conversely, potassium-sparing diuretics (e.g., spironolactone) can reduce renal sodium elimination.
• Corticosteroids: May cause sodium and fluid retention, amplifying the effects of sodium chloride.
• Antihypertensives: Volume expansion from sodium administration may reduce the efficacy of antihypertensive therapy.
• Lithium: Sodium intake affects lithium excretion and plasma levels. Increased sodium can lead to decreased lithium efficacy.
• Calcium or Magnesium-containing solutions: Mixing without compatibility assessment can result in precipitation or loss of therapeutic effect.

Drug compatibility should be assessed before mixing with other solutions. Always consult compatibility charts or a pharmacist when co-administering with other parenteral medications.

Dosage of 23.4% w/v SODIUM CHLORIDE INJECTION USP

The dosage of 23.4% Sodium Chloride Injection is individualized based on the patient’s clinical condition, severity of hyponatremia, and laboratory findings.

• General Dosing Guideline: Administer only after dilution. Typical dosages are based on the desired sodium correction (e.g., mEq of sodium required).
• For Hyponatremia: A commonly used approach involves calculating sodium deficit using the formula: Sodium Deficit = (Desired Na+ - Current Na+) × Total Body Water.
• Infusion Rate: Should not exceed 0.5 mEq/L/hr in chronic hyponatremia or 1 mEq/L/hr in acute symptomatic cases to avoid central pontine myelinolysis.
• Maximum Daily Dose: Should be carefully controlled to avoid sodium overload and hypernatremia.
• Administration: Slow IV infusion via a central line is preferred due to its hyperosmolar nature.

Dose adjustments must be made frequently based on lab results and patient response. Rapid corrections can have serious neurological consequences.

Possible side effects of 23.4% w/v SODIUM CHLORIDE INJECTION USP

While essential for specific clinical situations, 23.4% Sodium Chloride Injection carries a high risk of adverse effects due to its hypertonicity.

• Hypernatremia: The most significant risk; symptoms include restlessness, irritability, lethargy, muscle twitching, and in severe cases, seizures or coma.
• Fluid Overload: May cause edema, hypertension, or pulmonary congestion, especially in patients with renal or cardiac dysfunction.
• Local Irritation: Pain, redness, or phlebitis at the injection site if administered through peripheral veins.
• Osmotic Demyelination Syndrome (ODS): Risk when correcting chronic hyponatremia too rapidly.
• Metabolic Disturbances: Hyperchloremic metabolic acidosis can occur due to excess chloride ions.

Patients receiving this solution must be monitored closely for clinical and laboratory signs of adverse effects. Immediate action is required if symptoms of sodium overload appear.

23.4% w/v SODIUM CHLORIDE INJECTION USP Contraindications 23.4% w/v SODIUM CHLORIDE INJECTION USP

Use of 23.4% Sodium Chloride Injection is contraindicated in certain conditions where sodium or fluid overload would pose serious health risks.

• Hypernatremia: Absolute contraindication as it would worsen sodium overload.
• Severe Renal Impairment: Risk of fluid retention and inability to excrete excess sodium.
• Congestive Heart Failure (CHF): Risk of fluid overload and pulmonary edema.
• Severe Hypertension: Sodium may exacerbate elevated blood pressure.
• Peripheral or Pulmonary Edema: Increased sodium and fluid may worsen edema.
• Incompatibility: Should not be administered concurrently with incompatible drugs or solutions without prior dilution and mixing assessment.

This solution must not be used unless the anticipated benefit outweighs the potential risks in vulnerable populations.

Storage of 23.4% w/v SODIUM CHLORIDE INJECTION USP

Proper storage conditions are crucial to maintain the sterility and chemical stability of 23.4% Sodium Chloride Injection.

• Storage Temperature: Store at controlled room temperature, between 15°C to 25°C (59°F to 77°F).
• Avoid Freezing: Do not freeze, as this may cause container integrity issues or precipitation of salts.
• Container Integrity: Use only if the solution is clear and the container is intact. Inspect for leaks or discoloration before use.
• Light Protection: Generally stable in normal light; no special light protection required.
• Shelf Life: Follow expiration date indicated on the packaging. Discard any unused portion after opening.

Ensure proper inventory rotation (first-expiry-first-out) in healthcare settings to minimize waste and ensure safety.