Hypertonic saline

Decision to administer hypertonic saline must be made by the patient's home team ST3 or more senior. Please contact Endocrinology within working hours for review of any patient who has needed hypertonic saline. Endocrinology can be contacted out of hours by the patient's home team ST3 or senior if there are concerns or uncertainty.

1. A single aliquot of 300mls of sodium chloride 1.8% over 30 minutes is recommended
   - as per IV guide, Sodium chloride 1.8% has a high osmolarity and may cause venous irritation and tissue damage in cases of extravasation. If a central venous access device is unavailable, administer via a large peripheral vein monitoring insertion site closely using a recognised phlebitis scoring tool, re-site cannula at first signs of inflammation.
   - The infusion must be stopped immediately if there is any evidence of extravasation at any point during the treatment.
   
   
2. Serum sodium must be checked after the infusion and then a minimum of 4 hourly thereafter at least until the serum sodium is >125 mmol/L. Please do not take sample from the drip arm
3. Further infusions of hypertonic sodium chloride 1.8% may be required and the aim should be a 5 mmol/L increase in serum sodium with no more than a 10 mmol/L rise in the first 24 hours, and then 8 mmol/L rise every 24 hours thereafter. (Therefore a second infusion should only be given once the post-infusion serum sodium level is known and further specialist endocrine/renal advice has been obtained)
4. Monitor urine output hourly. A sudden increase in urine output to >100 ml/hour signals increased risk of rapid correction of hyponatraemia and U&Es should be rechecked