NCL

Intravenous Therapy

• Volume replacement in hypovolemia, hemorrhage, dehydration, shock, and sepsis
• Fluid and electrolyte maintenance in peri-operative and critical care settings
• Diluent for IV medications and blood products

Inhalation (Nebulizer)

• Hydration of airway secretions in cystic fibrosis, bronchiolitis, chronic bronchitis
• Adjunctive mucolytic therapy

Topical/Ophthalmic

• Wound irrigation in minor injuries or surgical wounds
• Nasal saline irrigation for nasal congestion, allergic rhinitis
• Contact lens solution for cleaning and rinsing lenses
• Eye drops for dry eye lubrication

Intravenous (IV):

• Adults:
• Resuscitation / Hypovolemia: 500–2000 mL bolus, repeat based on clinical response
• Maintenance: 20–40 mL/kg/day
• Hypertonic (e.g., 3%, 5%): Used cautiously in specialized cases (e.g., cerebral edema)
• Pediatrics:
• Maintenance: 40–60 mL/kg/day
• Bolus: 20 mL/kg for acute resuscitation
• Neonates:
• Bolus: 10–20 mL/kg as needed; maintenance per weight

Inhalation:

• 3–5 mL of 0.9%–7% saline via nebulizer, 1–4 times daily

Ophthalmic / Topical / Nasal:

• Eye drops: 1–2 drops 2–6 times daily
• Wound/nasal irrigation: 2–4 times daily

Special Populations:
Adjust rates in renal, cardiac, or elderly patients to prevent fluid/electrolyte disturbance.

• IV Fluids: Sodium and chloride ions restore extracellular fluid, maintain osmotic balance, and support hemodynamics.
• Nebulized Saline: Creates osmotic gradient, drawing water into airway mucus and enhancing mucociliary clearance.
• Topical/ Ophthalmic Application: Provides isotonic cleansing and lubrication without disturbing local cells.

• Absorption & Distribution: IV administration provides immediate distribution in extracellular fluid. Nebulized and topical forms act locally with negligible systemic absorption.
• Metabolism: No metabolism; sodium and chloride follow renal regulation.
• Elimination: Excess sodium and chloride are excreted by kidneys; bicarbonate may adjust for acid-base balance.
• Onset & Duration: IV—immediate; nebulized/local—minutes; corrective effects last while administered.

• Pregnancy: Safe with IV and topical use. Monitor fluid balance in preeclampsia or cardiac conditions.
• Breastfeeding: Safe across all routes; negligible risk to the infant.

• Primary Class: Fluid & Electrolyte Replacement
• Subclasses:
• Crystalloid IV solutions
• Nebulization solution
• Ophthalmic lubricator
• Wound irrigant

• Hypernatremia or overly high chloride levels
• Uncontrolled fluid overload (e.g., heart failure, renal failure)
• Hypertension without fluid control
• Severe pulmonary or cerebral edema
• Nebulized use contraindicated in acute bronchospasm without a bronchodilator

• Monitor for fluid overload, especially in cardiac or renal impairment
• Risk of hypernatremia or hyperchloremic metabolic acidosis
• Nebulized saline can cause bronchospasm—pre-treat in sensitive patients
• Maintain strict aseptic technique to avoid contamination (IV, topical, ophthalmic)

Systemic (IV):

• Edema, hypertension, hypernatremia, metabolic acidosis, phlebitis

Inhalation:

• Coughing, bronchospasm, chest tightness

Topical/Ophthalmic:

• Mild stinging, redness, transient discomfort

Rarely, allergic or irritant reactions may occur.

• Lithium: Sodium intake may decrease lithium reabsorption
• Diuretics/Antihypertensives: Alters fluid and electrolyte balance
• Corticosteroids: Potential for increased fluid retention
• Bronchodilators: Nebulized saline may necessitate pre-treatment in asthma/COPD

No significant CYP450 enzyme interactions.

• Critical care shifting toward balanced crystalloids over plain NaCl to minimize renal injury and acidosis
• Nebulized saline endorsed in cystic fibrosis and bronchiolitis, with preventative measures against bronchospasm
• Topical and ophthalmic saline remain standard of care for cleansing and lubrication

• IV Bags: 20–25 °C; do not freeze; use aseptic technique; discard after opening
• Nebulizer Bottles: Store closed at room temperature; discard after opening
• Topical / Ophthalmic Bottles: Store below 30 °C; protect from moisture and light; discard after 28 days once opened