NORMAL SALINE INFUSION

Indications

• Primary immunodeficiency syndromes
• Secondary immunodeficiency
• Immunomodulation in certain autoimmune disorders
• Prevention of infections in patients undergoing immunosuppressive therapy

Dosage

Children: Refer to the BNF for Children for specific dosing recommendations in pediatric patients, as it varies based on age, weight, and clinical condition.

Adults: Refer to the BNF for specific dosing recommendations for adults, as it varies based on clinical indications and patient circumstances.

Mechanism of action

Normal immunoglobulin works by providing a broad spectrum of antibodies that neutralize pathogens and enhance the immune response. These antibodies bind to pathogens, facilitating their removal by immune cells and providing immediate passive immunity against infections.

Pharmacodynamics

The pharmacodynamic effects of normal immunoglobulin include the neutralization of toxins and pathogens, opsonization, and enhancement of phagocytosis. It modulates immune responses and provides immediate humoral immunity, particularly in individuals with inadequate antibody production.

Pharmacokinetics

Normal immunoglobulin is administered intravenously or subcutaneously. After administration, it is distributed throughout the body, with a half-life of approximately 21 to 30 days. It is metabolized by the reticuloendothelial system, and the rate of clearance can vary based on individual patient factors and the presence of underlying conditions.

Interactions

• normal immunoglobulin + monoclonal antibodies: Severe (affects effects)
• normal immunoglobulin + dinutuximab: Severe (affects effects)
• normal immunoglobulin + live vaccines, measles, mumps and rubella vaccine, live, rotavirus vaccine, typhoid vaccine, oral, varicella-zoster vaccine: Unknown (decreases efficacy)
• normal immunoglobulin + bacillus Calmette-Guérin vaccine: Unknown (decreases efficacy)
• normal immunoglobulin + herpes-zoster vaccine: Unknown (decreases efficacy)
• normal immunoglobulin + live: Unknown (decreases efficacy)
• normal immunoglobulin + influenza vaccine, live: Unknown (decreases efficacy)

Pregnancy

Consult relevant guidelines for use in pregnancy.

Breast-feeding

Consult relevant guidelines for use during breastfeeding.

Storage

Store at 2-8°C. Do not freeze.

Indications

• Fluid replacement therapy in dehydration
• Electrolyte replenishment
• As a diluent for intravenous medications
• Wound irrigation
• Intra-amniotic instillation for abortion procedures

Dosage

Children: Paediatric dosing of saline is dependent

Adults: The dosage of saline varies depending on the clinical indication. For fluid resuscitation, isotonic saline (0.9% NaCl) is typically administered at a rate determined by the patient's condition and response to therapy. Refer to specific clinical guidelines for detailed dosing.

Mechanism of action

Sodium and chloride, the major electrolytes in extracellular fluid, control extracellular volume and blood pressure. Changes in sodium concentrations are linked to water balance disorders. Intra-amniotic instillation of hypertonic sodium chloride injection may induce abortion, potentially mediated by prostaglandins released from damaged decidual cells, resulting in uterine contractions that lead to evacuation of the fetus and placenta.

Pharmacodynamics

Sodium, as the principal cation in extracellular fluid, regulates water distribution, fluid balance, and osmotic pressure. It plays a crucial role in maintaining acid-base equilibrium in conjunction with chloride and bicarbonate. Chloride, the major extracellular anion, closely follows sodium metabolism, with fluctuations in acid-base balance reflected in chloride concentrations.

Pharmacokinetics

Saline is administered intravenously or through other routes depending on clinical needs. Once in the body, sodium and chloride are distributed in the extracellular fluid compartment. The elimination of sodium occurs primarily through renal excretion, while chloride follows similar pathways. The pharmacokinetic properties can vary based on the concentration of the saline solution and the physiological state of the patient.

Pregnancy

Saline is generally considered safe for use during pregnancy, but its use should be justified based on the clinical situation.

Breast-feeding

Saline is considered safe to use during breastfeeding, as it is not expected to affect the milk or nursing infant.

Storage

Store at room temperature, away from light and moisture. Do not freeze.

Formulations

• 0.9% Sodium Chloride Injection
• 20% Sodium Chloride Injection

Mechanism of action

Sodium and chloride - major electrolytes of the fluid compartment outside of cells (i.e., extracellular) - work together to control extracellular volume and blood pressure. Disturbances in sodium concentrations in the extracellular fluid are associated with disorders of water balance. Intra-amniotic instillation of 20% sodium chloride injection induces abortion and fetal death. Although the mechanism has not been conclusively determined, some studies indicate that the drug's abortifacient activity may be mediated by prostaglandins released from decidual cells damaged by hypertonic solutions of sodium chloride. Hypertonic sodium chloride-induced uterine contractions are usually sufficient to cause evacuation of both the fetus and placenta; however, abortion may be incomplete in 25-40% of patients. /20% injection/

Pharmacodynamics

Sodium, the major cation of the extracellular fluid, functions primarily in the control of water distribution, fluid balance, and osmotic pressure of body fluids. Sodium is also associated with chloride and bicarbonate in the regulation of the acid-base equilibrium of body fluid. Chloride, the major extracellular anion, closely follows the metabolism of sodium, and changes in the acid-base balance of the body are reflected by changes in the chloride concentration.