TASALINE 0.9% SOLUTION FOR INFUSION / INJECTION

Indications

• Fluid and electrolyte imbalances
• Hyponatremia
• Diabetic ketoacidosis
• Prophylaxis of sodium chloride deficiency
• Chronic renal salt wasting
• Dry eye conditions (as eye drops)

Dosage

Children: Refer to the BNF for Children for appropriate dosing guidelines based on the child's age and clinical condition.

Adults: Fluid and electrolyte replacement should be individualized based on clinical circumstances. For oral supplementation, adult patients may take 4-8 tablets daily, with a maximum of 20 tablets in severe depletion. For intravenous infusion, the volume of sodium chloride solution required to replace deficits may vary; consult product literature for precise guidance.

Mechanism of action

Sodium and chloride ions function together to control extracellular volume and blood pressure. Disturbances in sodium concentrations in the extracellular fluid can lead to water balance disorders. Sodium chloride can induce uterine contractions when used in hypertonic solutions, contributing to its abortifacient properties. The precise mechanism may involve prostaglandins released from damaged decidual cells.

Pharmacodynamics

Sodium, as the primary cation in extracellular fluid, is essential for maintaining fluid distribution, osmotic pressure, and overall fluid balance. It works in conjunction with chloride and bicarbonate to regulate the acid-base equilibrium of body fluids. Changes in sodium levels significantly impact water distribution and electrolyte balance within the body.

Pharmacokinetics

Sodium chloride is readily absorbed and distributed in body fluids, influencing extracellular fluid volume and osmotic pressure. It is excreted primarily through the kidneys, with renal function significantly affecting sodium retention and excretion. The pharmacokinetics may vary based on the route of administration (oral or intravenous) and the formulation used.

Adverse effects

• Abdominal cramps
• Acidosis
• Hyperchloraemic diarrhoea
• Generalised oedema
• Hypertension
• Hypotension
• Irritability
• Muscle complaints
• Nausea
• Vomiting
• Chills
• Fever
• Hypervolemia
• Local reaction
• Localized pain
• Paraesthesia
• Skin reactions
• Tremor
• Vascular irritation
• Venous thrombosis

Precautions

• Avoid excessive administration in elderly patients or those with cardiac failure.
• Monitor for signs of fluid overload, especially in patients with impaired renal function.
• Consider potential for dilutional hyponatraemia.

Pregnancy

Intra-amniotic instillation of hypertonic sodium chloride can induce abortion and fetal death; caution is advised.

Storage

Store in a cool, dry place, away from direct sunlight. Ensure containers are tightly closed.

Formulations

• Sodium chloride 0.9% infusion
• Sodium chloride 5% eye drops
• Sodium chloride effervescent tablets

Indications

• Relief of discomfort in mild urinary tract infections
• Alkalinization of urine
• Management of metabolic acidosis

Dosage

Children: Refer to BNF for Children for specific dosing in paediatric patients.

Adults: 10 mL three times a day, diluted well with water.

Mechanism of action

Sodium citrate acts as a systemic alkalinizing agent. In the body, it is metabolized to bicarbonate, which helps to neutralize excess acid in the blood and urine, thus raising the pH and promoting the solubility of uric acid and cystine. This process can aid in the prevention of certain types of kidney stones and alleviate symptoms associated with acidotic states.

Pharmacodynamics

The pharmacodynamic effects of sodium citrate include the alkalinization of urine, which can help dissolve uric acid and cystine stones. By increasing urine pH, it enhances the solubility of these substances and reduces crystallization. Additionally, sodium citrate can help in managing metabolic acidosis by increasing bicarbonate concentrations in the bloodstream.

Pharmacokinetics

Sodium citrate is readily absorbed from the gastrointestinal tract. Following absorption, it is metabolized in the liver to bicarbonate, which is then distributed throughout the body. The elimination half-life is variable and depends on the individual's renal function and metabolic state. In patients with renal impairment, caution is advised due to the risk of hyperkalemia and electrolyte imbalances.

Contra-indications

• Addison’s disease
• dehydration
• hyperkalaemia
• ventricular arrhythmia
• inflammatory bowel disease
• intestinal obstruction

Adverse effects

• hyperkalaemia
• nausea
• vomiting
• gastrointestinal discomfort
• electrolyte imbalance
• metabolic acidosis
• chills

Interactions

• methenamine: Severe (decreases efficacy)
• sucralfate: Severe (increases risk of adverse effects)

Precautions

• Use with caution in cardiac disease
• Use with caution in the elderly
• Use with caution in renal impairment
• Use with caution in hepatic impairment

Pregnancy

Use only if clearly needed, as safety has not been established.

Breast-feeding

Use with caution, as it is not known whether sodium citrate is excreted in human milk.

Storage

Store at room temperature, protected from light. Keep out of reach of children.

Formulations

• Oral solution containing citric acid and potassium citrate
• Effervescent tablets containing citric acid and potassium citrate
• Sodium citrate for bladder washouts

Indications

• Hyponatremia
• Electrolyte imbalance
• Fluid replacement therapy

Dosage

Children: Refer to the BNF for Children for specific paediatric dosing recommendations.

Adults: Refer to the BNF for specific dosing guidelines.

Mechanism of action

Sodium acetate works as a source of sodium ions, especially in patients with hyponatremia. Sodium is essential for regulating extracellular fluid volume, controlling water distribution, fluid and electrolyte balance, and the osmotic pressure of body fluids. It also plays a vital role in nerve conduction, muscle contraction, acid-base balance, and cell nutrient uptake.

Pharmacodynamics

Sodium is the principal cation of extracellular fluid, making up more than 90% of total cations at its normal plasma concentration of approximately 140 mEq/liter. It plays a primary role in controlling total body water and its distribution. Additionally, acetate ions act as hydrogen ion acceptors, serving as an alternative to bicarbonate in physiological processes.

Pregnancy

There are no adequate and well-controlled studies in pregnant women. Sodium acetate should be used during pregnancy only if the potential benefit justifies the potential risk to the fetus.

Breast-feeding

Sodium acetate is excreted in breast milk, but the effects on a nursing infant are unknown. Caution should be exercised when administering to a breastfeeding mother.

Storage

Store at room temperature, away from light and moisture. Keep out of reach of children.

Formulations

• Sodium acetate injection
• Sodium acetate oral solution

Mechanism of action

It works as a source of sodium ions especially in cases of hyponatremic patients. Sodium has a primary role in regulating extracellular fluid volume. It controls water distribution, fluid and electrolyte balance and the osmotic pressure of body fluids. Sodium is also involved in nerve conduction, muscle contraction, acid-base balance and cell nutrient uptake.

Pharmacodynamics

Sodium is the principal cation of extracellular fluid. It comprises more than 90% of total cations at its normal plasma concentration of approximately 140 mEq/liter. The sodium ion exerts a primary role in controlling total body water and its distribution. Acetate ions acts as hydrogen ion acceptor which is alternative to bicarbonate.

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.