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    FATMA

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    Amr Ramazan Ibrahim
    The document discusses normal saline solution, including its introduction, uses, mechanism of action, administration, adverse effects, monitoring, contraindications, and references. Normal saline is a commonly used intravenous fluid that can be used for hydration, electrolyte disturbances, and other indications. It comes in 0.9% and 0.45% concentrations and is administered intravenously after considering factors like a patient's weight, age, and condition.

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    FATMA

    Uploaded by

    Amr Ramazan Ibrahim
    5 views8 pages
    The document discusses normal saline solution, including its introduction, uses, mechanism of action, administration, adverse effects, monitoring, contraindications, and references. Normal saline is a commonly used intravenous fluid that can be used for hydration, electrolyte disturbances, and other indications. It comes in 0.9% and 0.45% concentrations and is administered intravenously after considering factors like a patient's weight, age, and condition.

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    The document discusses normal saline solution, including its introduction, uses, mechanism of action, administration, adverse effects, monitoring, contraindications, and references. Normal saline is a commonly used intravenous fluid that can be used for hydration, electrolyte disturbances, and other indications. It comes in 0.9% and 0.45% concentrations and is administered intravenously after considering factors like a patient's weight, age, and condition.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    5 views8 pages

    FATMA

    Uploaded by

    Amr Ramazan Ibrahim
    The document discusses normal saline solution, including its introduction, uses, mechanism of action, administration, adverse effects, monitoring, contraindications, and references. Normal saline is a commonly used intravenous fluid that can be used for hydration, electrolyte disturbances, and other indications. It comes in 0.9% and 0.45% concentrations and is administered intravenously after considering factors like a patient's weight, age, and condition.

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    of 8

    Nobel Technical Private Institute

    Nursing Department
    First Stage

    NORMAL SALINE SOLUTION

    Prepared by: Fatima Omar Mohammed


    Supervised by: Ms. Shadan
    00 TABLE OF CONTENTS

    01. Introduction to normal saline solution.

    02. What is saline solution used for?

    03. Mechanism of action.

    04. Administration.

    05. Adverse effects.

    06. Monitoring.

    07. Contraindications.

    08. References.

    1
    01 INTRODUCTION TO NORMAL SALINE SOLUTION.

    Normal saline is a cornerstone of intravenous solutions commonly used in the clinical


    setting. It is a crystalloid fluid administered via an intravenous solution. Its indications
    include both adult and pediatric populations as sources of hydration and electrolyte
    disturbances. It can come in various concentrations; the two specifically addressed are
    0.9% and 0.45%.
    The following are primary indications for the use of normal saline infusion that have
    been approved by the FDA:
     Extracellular fluid replacement (e.g., dehydration, hypovolemia, hemorrhage, sepsis)
     Treatment of metabolic alkalosis in the presence of fluid loss.
     Mild sodium depletion
    Additionally, it has a use as a priming solution for various procedures (e.g.,
    hemodialysis procedures) and to initiate and terminate blood transfusions. Indications
    for sodium chloride infusions also include pharmaceutic aids and diluents for the
    infusion of compatible drug additives.
    0.9% Sodium Chloride (Normal Saline)
    An isotonic concentration of sodium chloride is best suited for the parenteral
    replacement of chloride losses that exceed or equal the sodium loss. Within each 100
    mL of 0.9% sodium chloride Injection USP, there is 15.4 mEq of sodium ions and 15.4
    mEq of chloride ions. Additionally, the osmolarity is 308 mOsmol/liter, and it has a pH
    range of 4.5 to 7.
    0.45% Sodium Chloride
    A hypotonic concentration of sodium chloride. Hypotonic concentrations of sodium
    chloride (0.45%) are best for parenteral maintenance fluids rather than aggressive
    intravascular volume repletion. Within each 100 mL of 0.45% sodium chloride
    Injection USP, there is 7.7 mEq of sodium ions and 7.7 mEq of chloride ions. The
    osmolarity is 154 mOsmol/liter and a pH range similar to the 0.9% concentration.

    2
    02 WHAT IS SALINE SOLUTION USED FOR?

    Saline is often used in the medical field to clean wounds, clear out sinuses, and treat
    dehydration. However, it can also play an important part in caring for your eyes and
    contact lenses.

    03 MECHANISM OF ACTION.

    Normal saline is a crystalloid fluid. By definition, it is an aqueous solution of


    electrolytes and other hydrophilic molecules. The main indication for the use of
    crystalloid fluids in humans is due to their isotonic nature when compared to serum
    plasma. In comparison to other types of fluids (e.g., hypertonic, hypotonic), there is less
    of an osmotic effect. Normal saline contains electrolytes (sodium and chloride ions)
    which dissociate in solution.
    Sodium ions are the main electrolytes of extracellular fluid, integral in the distribution
    of fluids and other electrolytes. Another important ion is chloride, which serves as a
    buffering agent within the lungs and tissues. Here chloride helps to facilitate the
    binding between oxygen and carbon dioxide to hemoglobin. These ions are primarily
    under the regulation of the kidneys, which control homeostasis by absorption or
    excretion within the tubules.
    Additionally, water plays an equally important role. Water is a necessary ingredient of
    the body and comprises more than two-thirds of total body weight. Similarly, the
    balance of water is primarily under the control of the lungs and kidneys. The
    distribution of water depends mainly on the concentration of these electrolytes within
    various compartments. Within these compartments, sodium plays a significant role in
    sustaining homeostatic concentrations and the distribution of water. Normal saline
    functions to expand intravascular volume without disturbing ion concentration or
    causing large fluid shifts between intracellular, intravascular, and interstitial spaces.

    3
    04 ADMINISTRATION

    Normal saline solution can be administered only via intravenous access. When deciding
    dosage, the provider must take into account various patient factors (e.g., weight, age,
    clinical presentation, laboratory findings). Therefore, monitoring should focus on
    laboratory results and clinical evaluation (see ‘Monitoring’ section). Naturally, there
    are two methods of administration for normal saline:

     Fluid bolus
    This route is normally used in the acute care setting when a rapid infusion of fluids is
    necessary (e.g., hypovolemia). Delivery of fluid should be administered through
    large-bore peripheral lines or via central-line access.
     Maintenance
    The calculation of daily fluid requirements is achievable in various ways. Common
    practices utilize the formulas created by Drs. Holliday and Segar which indicate that
    one can use the "100-50-25" or "4-2-1" rules.

    Example:
    For a 50 kg patient
    First 10 kg weight = 1000 mL (100 mL/kg x 10)
    Second 10 kg weight = 500 mL (50 mL/kg x 10)
    Remaining 30 kg weight = 750 mL (25 mL/kg x 30)
    Total = 2250 mL/day or 94 mL/hr

    4
    05 ADVERSE EFFECTS

    The use of normal saline can contribute to iatrogenic fluid overload. This complication
    is particularly concerning in patients with impaired kidney function (acute kidney
    injury, chronic kidney disease, etc.), and these patients should, therefore, receive
    treatment with judicious use of intravenous fluids.
    Patients with congestive heart failure are at an increased risk for detrimental effects of
    normal saline administration. In these patients, fluid overload is a considerable concern;
    this can lead to life-threatening pulmonary edema and the worsening of diastolic or
    systolic heart failure, leading to end-organ damage or even death. It is vital for the
    clinician to monitor these patients carefully and to administer the minimum required
    volume to maintain homeostasis.
    Adverse effects of normal saline may occur secondary to solution or technique of
    administration. These effects include febrile response, infection at the site of injection,
    venous thrombosis or phlebitis extending from the site of injection, extravasation, and
    hypervolemia. Additionally, if infusing normal saline in large quantities, chloride ions
    will be vastly increased within the blood. This influx of hyperchlorhydria causes an
    intracellular shift of bicarbonate ions to allow for equilibria. Overall, this decreases the
    number of bicarbonate ions available for buffering. Due to the net acidosis, this
    physiological change will also cause an increase in serum potassium levels due to the
    transcellular shift of potassium from within the cell into the extracellular space.
    While the overuse of 0.45% sodium chloride can cause hyponatremia and cerebral
    edema, this is due to its hypotonic nature, creating a migration of water molecules into
    areas of higher sodium concentration.
    Therefore, if an adverse effect does occur, discontinuation of the infusion is strongly
    suggested. The patient should then undergo a clinical evaluation and the proper
    therapeutic countermeasures engaged. All while, the remainder of the fluid should be
    saved for examination if contamination is suspected.

    5
    06 MONITORING

    When monitoring the use of normal saline, there must be periodic assessments of the
    patient’s clinical and laboratory findings. Specifically, one must observe any changes in
    electrolyte concentrations, volume status, and acid-base disturbances. Significant
    deviations from normal concentrations may require tailoring of the electrolyte pattern
    in these or alternative solutions.
    Patients require evaluation for signs and symptoms of dehydration and fluid overload.
    Patients with elevated lactate and creatinine concentration are signs that they may not
    be receiving an adequate amount of volume. Also, the patient's volume status is
    assessable by monitoring urine output. Ideally, a urine output target of 0.5 mL/kg/hr
    indicates adequate hydration but may not be useful to determine volume status in
    patients with renal impairment. In such a case, providers must utilize other objective
    findings to evaluate fluid status (e.g., orthostatic, physical examination).
    Patients at high risk of developing fluid overload should receive frequent re-evaluation,
    especially patients with known cardiopulmonary diseases. Signs and symptoms of fluid
    overload can undergo an evaluation with a comprehensive physical exam. Clinicians
    should investigate for pulmonary edema (e.g., new or worsening crackles on lung
    exam), as well as any new or worsening peripheral edema in the extremities.
    Additionally, the infusion of more than one liter of isotonic (0.9%) sodium chloride per
    day may supply more sodium and chloride than physiological levels, which can lead to
    hypernatremia, as well as hyperchloremic metabolic acidosis. Therefore, patients
    receiving large volumes of normal saline require monitoring for electrolyte imbalances.
    To minimize the risk of possible contaminations, the final solution should be inspected
    for ambiguity or precipitation immediately after mixing, before administration, and
    periodically during administration.

    6
    07 CONTRAINDICATIONS

    Contraindications for the use of normal saline are evaluated clinically from patient to
    patient. If the implementation of normal saline results in dilution of serum electrolyte
    concentrations, over hydration, congested states, or pulmonary edema, then its use is
    strongly discouraged.

    07 REFERENCES

    01. Chang R, Holcomb JB. Choice of Fluid Therapy in the Initial Management of
    Sepsis, Severe Sepsis, and Septic Shock. Shock. 2016 Jul;46(1):17-26. [PMC free
    article] [PubMed]
    02. Neyra JA, Canepa-Escaro F, Li X, Manllo J, Adams-Huet B, Yee J, Yessayan L.,
    Acute Kidney Injury in Critical Illness Study Group. Association of
    Hyperchloremia With Hospital Mortality in Critically Ill Septic Patients. Crit Care
    Med. 2015 Sep;43(9):1938-44. [PMC free article] [PubMed]
    03. https://www.warbyparker.com/learn/what-is-saline-
    solution#:~:text=Saline%20is%20often%20used%20in,for%20your%20eyes%20an
    d%20contacts.
    04. Raghunathan K, Shaw AD, Bagshaw SM. Fluids are drugs: type, dose and
    toxicity. Curr Opin Crit Care. 2013 Aug;19(4):290-8. [PubMed
    05. Boyd JH, Forbes J, Nakada TA, Walley KR, Russell JA. Fluid resuscitation in
    septic shock: a positive fluid balance and elevated central venous pressure are
    associated with increased mortality. Crit Care Med. 2011 Feb;39(2):259-65.
    [PubMed]

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