Sodium Chloride

(pentahydrate)

💊 Chemical information

Chlorid sodný; Chlorure de Sodium; Cloreto de Sódio; Natrii chloridum; Natrio chloridas; Natriumklorid; Nátrium-klorid; Natriumkloridi; Salt; Sodio, cloruro de; Sodium, chlorure de; Sodu chlorek; Sodyum Klorür.
NaCl = 58.44.
CAS — 7647-14-5.
ATC — A12CA01; B05CB01; B05XA03.
ATC Vet — QA12CA01; QB05CB01; QB05XA03.

Pharmacopoeias.

In Chin., Eur., Int., Jpn, US, and Viet.

Ph. Eur. 6.2

(Sodium Chloride). A white or almost white, crystalline powder or colourless crystals or white or almost white pearls. Freely soluble in water; practically insoluble in dehydrated alcohol.

USP 31

(Sodium Chloride). Colourless cubic crystals or white crystalline powder. Soluble 1 in 2.8 of water, 1 in 2.7 of boiling water, and 1 in 10 of glycerol; slightly soluble in alcohol.

Equivalence.

Each g of sodium chloride represents about 17.1 mmol of sodium and of chloride. Sodium chloride 2.54 g is equivalent to about 1 g of sodium.

Storage.

Solutions of some sodium salts, including sodium chloride, when stored, may cause separation of solid particles from glass containers and solutions containing such particles must not be used.

💊 Adverse Effects

Adverse effects of sodium salts are attributable to electrolyte imbalances from excess sodium; there may also be effects due to the specific anion. Retention of excess sodium in the body usually occurs when there is defective renal sodium excretion. This leads to the accumulation of extracellular fluid to maintain normal plasma osmolality, which may result in pulmonary and peripheral oedema and their consequent effects. Hypernatraemia (a rise in plasma osmolality) is usually associated with inadequate water intake, or excessive water losses. It rarely occurs after therapeutic doses of sodium chloride, but has occurred with the use of hypertonic saline for induction of emesis or for gastric lavage and after errors in the formulation of infant feeds. Hypernatraemia may also occur after inappropriate intravenous use of hypertonic saline. The most serious effect of hypernatraemia is dehydration of the brain which causes somnolence and confusion progressing to convulsions, coma, respiratory failure, and death. Other symptoms include thirst, reduced salivation and lachrymation, fever, sweating, tachycardia, hypertension or hypotension, headache, dizziness, restlessness, irritability, weakness, and muscular twitching and rigidity. Gastrointestinal effects associated with acute oral ingestion of hypertonic solutions or excessive amounts of sodium chloride include nausea, vomiting, diarrhoea, and abdominal cramps. Excessive use of chloride salts may cause a loss of bicarbonate with an acidifying effect. Intra-amniotic injection of hypertonic solutions of sodium chloride, which has been used for termination of pregnancy, has been associated with serious adverse effects including disseminated intravascular coagulation, renal necrosis, cervical and uterine lesions, haemorrhage, pulmonary embolism, pneumonia, and death.
1. Moder KG, Hurley DL. Fatal hypernatremia from exogenous salt intake: report of a case and review of the literature. Mayo Clin Proc 1990; 65: 1587–94. Correction. ibid. 1991; 66: 439
2. Martos Sánchez I, et al. Hipernatremia grave por administración accidental de sal común. An Esp Pediatr 2000; 53: 495–8
3. Adeleye O, et al. Hypernatremia in the elderly. J Natl Med Assoc 2002; 94: 701–5
4. Coulthard MG, Haycock GB. Distinguishing between salt poisoning and hypernatraemic dehydration in children. BMJ 2003; 326: 157–60. Correction. ibid.; 497.

💊 Treatment of Adverse Effects

In patients with mild sodium excess, drinking water and restricting sodium intake is sufficient. However, in the event of recent acute oral overdose of sodium chloride, gastric lavage should be carried out along with general symptomatic and supportive treatment. Serumsodium concentrations should be measured, and if severe hypernatraemia is present this should be treated.

💊 Precautions

Sodium salts should be used with caution in patients with hypertension, heart failure, peripheral or pulmonary oedema, renal impairment, pre-eclampsia, or other conditions associated with sodium retention. When sodium supplements are given orally, adequate water intake should be maintained. Sustained-release tablets should not be given to patients with gastrointestinal disorders associated with strictures or diverticula because of the risk of obstruction. Sodium chloride solutions should not be used to induce emesis; this practice is dangerous and deaths from resulting hypernatraemia have been reported.

💊 Pharmacokinetics

Sodium chloride is well absorbed from the gastrointestinal tract. Excess sodium is mainly excreted by the kidney, and small amounts are lost in the faeces and sweat.

💊 Human Requirements

The body contains about 4 mol (92 g) of sodium of which about one-third is found in the skeleton and about half is present in the extracellular fluid. The body can adapt to a wide range of intakes by adjustment of renal excretion through physical and hormonal factors. Loss through the skin is significant only if excessive sweating occurs. Sodium requirements may be increased with exercise or exposure to high ambient temperatures in the short term, until the body adjusts. Sodium is widely available in foods and is also added as salt during processing, cooking, and at the table. Dietary deficiency of sodium is therefore extremely rare and more concern has been expressed that current intakes are excessive. Restriction of sodium intake, by limiting the amount of culinary salt consumed, may be a useful aid in the management of some patients with hypertension.

UK and US recommended dietary intake.

In the UK dietary reference values1have been published for sodium. The reference nutrient intake (RNI) for adults is 1.6 g of sodium (70 mmol) daily, which is about 4 g of sodium chloride. In the USA, it has been recommended that daily intakes of sodium be limited to 2.4 g (6 g of sodium chloride) or less.2 Dietary intake is often in excess of these recommendations, and may be a factor in essential hypertension,3 and osteoporosis.4
1. DoH. Dietary reference values for food energy and nutrients for the United Kingdom: report of the panel on dietary reference values of the committee on medical aspects of food policy. Report on health and social subject
41. London: HMSO, 1991
2. Subcommittee on the tenth edition of the RDAs, Food and Nutrition Board, Commission on Life Sciences, National Research Council. Recommended dietary allowances. 10th ed. Washington, DC: National Academy Press, 1989. Also available at: http://www.nap.edu/openbook.php?isbn=0309046335 (accessed 21/07/08
3. Midgley JP, et al. Effect of reduced dietary sodium on blood pressure: a meta-analysis of randomized controlled trials. JAMA 1996; 275: 1590–7
4. Devine A, et al. A longitudinal study of the effect of sodium and calcium intakes on regional bone density in postmenopausal women. Am J Clin Nutr 1995; 62: 740–5.

💊 Uses and Administration

Sodium chloride is used in the management of deficiencies of sodium and chloride ions in salt-losing conditions. Sodium chloride solutions are used as a source of sodium chloride and water for hydration. A 0.9% solution in water is iso-osmotic, and thus in most cases isotonic with serum and lachrymal secretions. Doses may be expressed in terms of mEq or mmol of sodium, mass (mg) of sodium, or mass of sodium salt. A typical oral replacement dose of sodium chloride in chronic salt-losing conditions is about 2.4 to 4.8 g (about 40 to 80 mmol of sodium) daily as a modifiedrelease preparation, accompanied by a suitable fluid intake; doses of up to 12 g daily may be necessary in
Table 4. Some sodium salts and their sodium content. Sodium content per g Sodium salt mg mmol mEq Sodium acetate (anhydrous) 280 12.2 12.2 Sodium acetate (trihydrate) 169 7.3 7.3 Sodium acid citrate 175 7.6 7.6 Sodium bicarbonate 274 11.9 11.9 Sodium chloride 394 17.1 17.1 Sodium citrate (anhydrous) 267 11.6 11.6 Sodium citrate (dihydrate) 235 10.2 10.2 Sodium lactate 205 8.9 8.9 severe cases. Oral supplements are also used for the prevention of muscle cramps during routine haemodialysis; a suggested dose is about 6 to 10 g of a modified-release preparation per dialysis session. Glucose facilitates the absorption of sodium from the gastrointestinal tract, and solutions containing sodium chloride and glucose usually with additional electrolytes are used for oral rehydration in acute diarrhoea. The concentration and dosage of sodium chloride solutions for intravenous use is determined by several factors including the age, weight, and clinical condition of the patient and in particular the patients’ hydration state. Serum-electrolyte concentrations should be carefully monitored. In severe sodium depletion, 2 to 3 litres of sodium chloride 0.9% may be given over 2 to 3 hours and thereafter at a slower rate. If there is combined water and sodium depletion a 1 to 1 mixture of sodium chloride 0.9% and glucose 5% may be appropriate. Although hypertonic sodium chloride solutions may be used in certain patients with severe acute dilutional hyponatraemia, over-rapid correction may have severe neurological adverse effects. Solutions containing 1.8 to 5% are available. In hypernatraemia with volume depletion, sodium chloride 0.9% may be used to maintain plasma-sodium concentrations with expanding fluid volume. Sodium chloride 0.9% (or rarely, in marked hypernatraemia, 0.45%) is used for fluid replacement in diabetic ketoacidosis. Among its other uses, sodium chloride solution 0.9%, being isotonic, is a useful fluid for sterile irrigations, for example, of the eye or bladder, and general skin or wound cleansing. The 0.9% concentration is also widely used as a vehicle or diluent for the parenteral administration of other drugs. Nasal drops of sodium chloride 0.9% are used to relieve nasal congestion. A mouthwash containing sodium chloride is also available for oral hygiene. Sodium chloride solutions should not be used to induce emesis; this practice is dangerous and deaths from resulting hypernatraemia have been reported. Sodium chloride is sometimes used as an excipient in capsules and tablets.

Homoeopathy.

Sodium chloride has been used in homoeopathic medicines under the following names: Natrium muriaticum; Nat. Mur.; Natrii chloridum; Natricum chloratum; Natrum muriaticum. NOTE. Do not confuse Natricum chloratum with sodium chlorate.

Catheters and cannulas.

For reference to sodium chloride 0.9% being used to maintain the patency of catheters and cannulas, and to its equivalent efficacy to heparin, see Catheters and Cannulas under Uses and Administration of Heparin.

Cystic fibrosis.

Inhalation of 4 mL of a hypertonic solution of sodium chloride (7%) twice daily for 48 weeks in 82 patients with stable cystic fibrosis was associated with a moderate but sustained improvement in lung function and a marked reduction in the number of exacerbations and need for antibiotics, when compared with 80 placebo-treated patients.1 There was, however, no difference in the rate of change of lung function. Each inhalation was preceded by a bronchodilator to minimise airway narrowing; adverse reactions to the active treatment were nonetheless reported in 14 patients and included cough, chest tightness or pharyngitis, sinusitis, haemoptysis, sneezing, and vomiting. As a result, 6 patients withdrew from the study, but the effects resolved in the remainder without the need for dose reduction or interruption. Hypertonic saline was considered to be an inexpensive and safe adjunctive therapy in patients with cystic fibrosis.
1. Elkins MR, et al. A controlled trial of long-term inhaled hypertonic saline in patients with cystic fibrosis. N Engl J Med 2006; 354: 229–40.

Termination of pregnancy.

Trans-abdominal intra-amniotic instillation of sodium chloride 20% (maximum volume 200 to 250 mL) has been used for the termination of second-trimester pregnancy. However, serious adverse effects have occurred (see above), and other methods are generally preferred.

💊 Preparations

BP 2008: Compound Sodium Chloride Mouthwash; Potassium Chloride and Sodium Chloride Intravenous Infusion; Potassium Chloride, Sodium Chloride and Glucose Intravenous Infusion; Sodium Chloride and Glucose Intravenous Infusion; Sodium Chloride Eye Drops; Sodium Chloride Eye Lotion; Sodium Chloride Intravenous Infusion; Sodium Chloride Irrigation Solution; Sodium Chloride Oral Solution; Sodium Chloride Solution; Sodium Chloride Tablets; USP 31: Bacteriostatic Sodium Chloride Injection; Dextrose and Sodium Chloride Injection; Fructose and Sodium Chloride Injection; Half-strength Lactated Ringer’s and Dextrose Injection; Inulin in Sodium Chloride Injection; Lactated Ringer’s and Dextrose Injection; Lactated Ringer’s Injection; Mannitol in Sodium Chloride Injection; Potassium Chloride in Dextrose and Sodium Chloride Injection; Potassium Chloride in Lactated Ringer’s and Dextrose Injection; Potassium Chloride in Sodium Chloride Injection; Sodium Chloride and Dextrose Tablets; Sodium Chloride Inhalation Solution; Sodium Chloride Injection; Sodium Chloride Irrigation; Sodium Chloride Ophthalmic Ointment; Sodium Chloride Ophthalmic Solution; Sodium Chloride Tablets; Sodium Chloride Tablets for Solution.

Proprietary Preparations

Arg.: Aqua Lent Limpia Cristales; Hypersol; Larmabak; Muro 128; Nasomicina Salina†; Oftalook; Relente; Salfis†; Xylisol; Yusin Tears I; Austral.: Bausch & Lomb Sensitive Eyes Saline; Fess; Hypergel; Lens Plus; Mucolyt†; Narium; Otrivin Saline Baby; Slow-Sodium; Austria: Ery-Set; SmartDose; Uro-Pract†; Belg.: Lyomer Plus; Naaprep†; Natriclo†; Physiologica; Physiorhine; Braz.: Afrin Natural; Alive; Fluimare; Fluimucil Solucao Nasal; Maxidrate; Multisoro; Narisoro; Nasolac†; Nazosoro†; Novo Rino-S; Rino-Ped†; Rinoben; Rinoflux; Rinosoro; Salsep; Sinustrat Solucao Natural; Snif; Sorine; Sorine Pediatrico; Soro Nasal†; Soroliv; Soroneo; Sterimar†; Canad.: Certified Nasal; Hypergel; Lens Plus Buffered Saline Solution†; Mesalt; Muro 128†; Nasal Physiologic Solution; Normigel; Rhinaris Saline; Safeway Nasal; Salinex; Softwear; Chile: Fisiolimp; Fludrop†; Larmabak; Pediasea; Printan; Respirex; Rinodan; Rinokid; Rinosteryl; Sinus; Sterimar; Suero Fisiologico†; Denm.: Viskose ojendraber; Fin.: Natrosteril; Fr.: Erjean; Hypergel; Irriclens; L’Oceane; Larmabak; Larmes Artificielles†; Normlgel; Physiologica; Physiomer; Physiosoin; Polyrinse; Selgine; Serophta; Sinomarin; Sterimar; Tonimer Baby; Versol†; Vesirig†; Ger.: Adsorbonac; Freka-Drainjet; Isogutt akut; Isotone Kochsalz; Isotonische Kochsalzlosung; Olynth salin; Otrisal†; Rhinomer; Rhinospray Atlantik; Rhinoton plus†; Sterimar†; Tetrisal; Gr.: Babynose†; Clinofar†; Larmabak†; Otrisalin†; Phy-O; Rhinodose†; Selva N†; Hong Kong: Atomic Enema; Larmabak; Nasal Physiological Solution; Sinomarin; Sterimar; Unison Enema; Hung.: Rins-Sal; Salsol A; Unilarm†; Indon.: Otsu-NS; Wida NSI; Irl.: Sterimar; Israel: Baby AF; Clean-AF; Drossanose; Normasol; Ocean Spray; Otrivini; Sterimar; Tinok AF; Tipotaf; UroTa i n e r † ; Ital.: Adsorbonac; Hydrabak; Libenar; Narhinel; Naribel†; Otrivin Baby; Physiodose; Physiomer; Rinowash; Serophta†; Sterimar; Malaysia: Sterimar; Mex.: Alcacat†; Corni Limp; Hiperton; Muro 128; Sterimar; Mon.: Unilarm; NZ: Narium; Philipp.: Larmabak; Physiomer; Salinase; Snif; Pol.: Solnasin; Port.: Libenar†; Lyomer†; Rhinomer†; Sterimar†; Tonimer†; Rus.: Salin (Салин); S.Afr.: Polyrinse; Vicks Vapomist; Singapore: Adsorbonac†; Larmabak; Sterimar; Spain: Antiedema; Apir Clorurado; Fisiologica; Fisiologico; Fisiologico Bieffe M; Fisiologico Braun; Fisiologico Farmacelsia; Fisiologico Isoton†; Fisiologico Mein; Fisiologico Serra Pamies; Fisiologico Vitulia; Flebobag Fisio; Fleboflex Salina Fisio; Fleboplast Fisio; Freeflex Cloruro Sodico; Irrigacion CLNA†; Meinvenil Fisiologico; Plast Apyr Fisiologico; Solucion Fisio; Suero Fisiologico; Suero Fisiologico Isoton; Suero Fisiologico†; Swed.: SmartDose†; Switz.: Drossa-Nose; Fluimare; Naaprep; nasmer; Nose Fresh†; Physiologic; Physiosoin; Rhinomer; Serophy; Siccoral; Sterimar†; Tracheo Fresh†; Triomer; Thai.: U-Enema; Tur k.: Berko-Fiz; Fizyolen; Fizyosol; Lyomer; Otrisalin; Physiodose; Physiologica Gifrer; Rhinomer; Ser Damla; Serum Fizyolojik; Sinomarin; Sterimar; Tonimer; UAE: Normaline; UK: Askina; Equaleze; Irriclens; Irripod; Miniversol; Normasol; Slow-Sodium; Stericlens; Sterimar; Steripod; Tubilux; Uriflex S; UroTai ne r M ; Ver s o l ; USA: Adsorbonac; Afrin Moisturizing Saline Mist; Ak-NaCl; Ayr Saline; Breathe Free; Broncho Saline; Dristan Saline Spray; HuMist Nasal Mist; Marlin Salt System; Muro 128; Muroptic; NaSal; Nasal Moist; Normaline; Ocean; Pretz; Salinex; SeaMist; Your Choice; Venez.: Larmabak; Nafavine. Multi-ingredient: Arg.: Dialitica II; Phylarm; Yusin Tears II; Austral.: Cardioplegia A; Minims Artificial Tears†; Austria: Gluco-Salzlosung; Osmofundin 10%; Belg.: Alcasol; Ocal; Physiologica; Braz.: Glicofisiologica†; Malvona†; Nasolin; Novo Rino; Rinotil†; Sinustrat; Sinustrat Vasoconstritor; Sorine Adulto; Canad.: Sclerodex; Chile: Concentrado Basico; Nasivin; Sal Lite; Sal Liviana En Sodio; Cz.: Acidigen†; Fr.: Amukine; Biolau; Cataridol†; Ceruspray; Dacryoserum; Emoform Gencives; Kamillosan Ocean; Ophtaclair; Phylarm†; Potensium sel de table; Proceane Isotonique; Rhinodoron; Selso; Serozinc; Ger.: Kochsalz mit Glucose; Mar Plus†; Nisita†; Nubral 4†; Nubral Forte†; Rhinodoron; Tutofusin S†; Weleda-Rheumasalbe M; Gr.: Eyesalt†; Hong Kong: Eye Wash; Hung.: Acidigen†; Nisita†; India: Andre; Catarest; Cato-Bell; Cotaryl; Neotomic; Irl.: Minims Artificial Tears; Israel: Lyteers; Snore-No-More; Ital.: Aquasalina†; AZ 15; IperClean; Kamillosan Ocean; Sterimar Cu; Sterimar Mn; Troca Flu Spray Nasale; Vulnopur; Mex.: Amuchina†; Nasalub; Neth.: Symbial; Norw.: Salidex; Philipp.: Soothing Eye Wash; Pol.: Gargarin; Sal Ems Artificiale; Sal Ems Factitium; Sal Vichy Factitium; Port.: Glucanet†; Glucosalino; S.Afr.: Mrs Johnsons American Soothing Syrup; Singapore: ENTsol; Spain: Apir Glucosalino; Flebobag Glucosalina; Fleboplast Glucosalina; Freeflex Glucosalina; Glucosalina; Glucosalino; Humectante; Meinvenil Glucosalina; Plast Apyr Glucosalino; Potasico; Solurrinol; Suero Glucosalino; Suero Potassico Bieffe ME†; Switz.: Amuchina Med; Glucosalin; Glucosaline; Kemerhinose; Narifresh; Nose Fresh au D-panthenol; Perfusion mixte; Pommade Nasale Radix†; Prorhinel; Rhinocure; Rhinocure simplex; Siccalix; Thai.: Eye-Gene; Eye-Gene Soft; Mano; Opsil†; Visotone; Turk. : Isodeksol; Izodeks; Kadeks; UK: Asonor; Blink; Minims Artificial Tears; USA: Chlor-3; Clear Eyes CLR; Massengill; Nasal-Ease; Slo-Salt-K†; Summers Eve Post-Menstrual; Temp Tab; Trichotine; Venez.: Dextro-Sal†; Fisiolin; Glucofisiologica†. results have been reported in patients with carbon monoxide poisoning.2,3 Its use has therefore been widely recommended, particularly in patients with severe poisoning. However, the availability of hyperbaric oxygen is limited, and it remains unclear which patients should receive therapy; a systematic review considered its value unproven.1 A controlled trial4 comparing hyperbaric oxygen with normobaric oxygen (at higher levels than commonly used) in patients with severe poisoning found no benefit from hyperbaric oxygen, but a later study5 using a different regimen did find a reduction in cognitive sequelae. Hyperbaric oxygen has been successfully used in pregnant patients with carbon monoxide poisoning6 and its use should possibly be considered earlier in pregnant patients due to the risks to the fetus from hypoxia.
1. Juurlink DN, et al. Hyperbaric oxygen for carbon monoxide poisoning. Available in The Cochrane Database of Systematic Reviews; Issu
1. Chichester: John Wiley; 2005 (accessed 20/06/08)
2. Gorman DF. Problems and pitfalls in the use of hyperbaric oxygen for the treatment of poisoned patients. Med Toxicol Adverse Drug Exp 1989; 4: 393–9
3. Hawkins M, et al. Severe carbon monoxide poisoning: outcome after hyperbaric oxygen therapy. Br J Anaesth 2000; 84: 584–6
4. Scheinkestel CD, et al. Hyperbaric or normobaric oxygen for acute carbon monoxide poisoning: a randomised controlled clinical trial. Med J Aust 1999; 170: 203–10
5. Weaver LK, et al. Hyperbaric oxygen for acute carbon monoxide poisoning. N Engl J Med 2002; 347: 1057–67
6. Van Hoesen KB, et al. Should hyperbaric oxygen be used to treat the pregnant patient for acute carbon monoxide poisoning: a case report and literature review. JAMA 1989; 261: 1039–43. Correction. ibid. 1990; 263: 2750.

💊 Uses

Carbon monoxide has been used in low concentrations as a tracer gas in measurements of lung function. Carbon monoxide labelled with carbon-11 may also be used to assess the blood volume.
Published October 07, 2018.