Abstract
Three percent sodium chloride (3% NaCl) is the treatment of choice for symptomatic hyponatremia. A barrier to the use of 3% NaCl is the perceived risk of both local infusion reactions and neurologic complications from overcorrection. We examine whether children’s hospital pharmacies have policies or practice guidelines for the administration of 3% NaCl and whether these pharmacies have restrictions on the administration of 3% NaCl in terms of rate, route, volume and setting. An Internet survey was distributed to the pharmacy directors of 43 children’s hospitals participating in the Children’s Hospital Association (CHA) network. The response rate was 65% (28/43). Ninety-three percent (26/28) of pharmacy directors reported a restriction for the administration of 3% NaCl, with 57% restricting its use through a peripheral vein or in a non-intensive care unit setting, 68% restricting the rate of administration and 54% restricting the volume of administration. Seventy-one percent (20/28) reported having written policy or practice guidelines. Only 32% of hospital pharmacies allowed 3% NaCl to be administered through a peripheral IV in a non-intensive care unit setting. The majority of children’s hospital pharmacies have restrictions on the administration of 3% NaCl. These restrictions could prevent the timely administration of 3% NaCl in children with symptomatic hyponatremia.
Highlights
Three-percent sodium chloride (3% NaCl, Na 513 mEq/L, 1027 mOsm/L) is a hyperosmolar agent primarily indicated for the treatment of hyponatremic encephalopathy or to raise the serum osmolality in other cases of increased intracranial pressure [1,2]
While local infusion reactions through a peripheral vein may occur with high-concentration total parenteral nutrition, potassium, or calcium, or 24% NaCl, this has not been reported with 3% NaCl [5,6]
Recent clinical trials have demonstrated the superior efficacy of an intermittent bolus compared to a continuous infusion of 3% NaCl in achieving a more rapid increase in serum sodium when administered through a peripheral vein for the treatment of hyponatremic encephalopathy [15,16]
Summary
Three-percent sodium chloride (3% NaCl, Na 513 mEq/L, 1027 mOsm/L) is a hyperosmolar agent primarily indicated for the treatment of hyponatremic encephalopathy or to raise the serum osmolality in other cases of increased intracranial pressure [1,2]. We introduced the concept of using intermittent 3% NaCl boluses (2 mL/kg with a maximum of 100 mL) over 10 min with a goal of increasing the serum sodium by 5–6 mEq/L for the treatment of symptomatic hyponatremia [10,11]. This approach allows for a controlled and rapid increase in serum sodium to reduce cerebral edema, while at the same time minimizing the possibility for overcorrection. We suspect that many hospital pharmacies may have established policies or practice guidelines restricting the use of 3% NaCl to avoid potential iatrogenic complications. The purpose of this study is to evaluate whether children’s hospital pharmacies have policies or practice guidelines for the administration of 3% NaCl and whether these pharmacies restrict the administration of 3% NaCl in terms of rate, route, volume and setting
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