Normal saline
This article is licensed under the GNU Free Documentation License. It uses material from the Wikipedia article "Normal_saline".

For other uses, see Saline.
Saline solution for intravenous infusion. The white port at the base of the bag is where additives can be injected with a hypodermic needle. The port with the blue cover is where the bag is spiked with an infusion set.
Child receiving an intravenous infusion
Saline solution for irrigation. This solution is used for irrigating wounds, tissues, body cavities, and bladders. Saline solution for irrigation should not be administered intravenously.

In medicine, saline (also saline solution) is a general term referring to a sterile solution of sodium chloride (table salt) in water. It is used for intravenous infusion, rinsing contact lenses, and nasal irrigation. Saline solutions are available in various formulations for different purposes. Salines are also used in cell biology, molecular biology and biochemistry experiments.

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Concentrations

Concentrations vary from low to normal to high. High concentrations are used rarely in medicine but frequently in molecular biology.

Normal

In medicine, normal saline (NS) is the commonly-used term for a solution of 0.9% w/v of NaCl, about 300 mOsm/L. Less commonly, this solution is referred to as physiological saline or isotonic saline, neither of which is technically accurate. NS is used frequently in intravenous drips (IVs) for patients who cannot take fluids orally and have developed or are in danger of developing dehydration or hypovolemia. NS is typically the first fluid used when hypovolemia is severe enough to threaten the adequacy of blood circulation and has long been believed to be the safest fluid to give quickly in large volumes. However, it is now known that rapid infusion of NS can cause metabolic acidosis 1. NS is 9g NaCl dissolved in 1 liter water. The mass of 1 milliliter of NS is 1.009 grams. The molecular weight of sodium chloride is approximately 58 g/mole, so 58g NaCl is 1 mole. Since NS contains 9 grams NaCl, the concentration is 9g/L divided by 58g/mole = 0.154 mole/L. Since NaCl dissociates into two ions – sodium and chloride – 1 molar NaCl is 2 osmolar. Thus, NS contains 154 mEq/L of Na+ and Cl−. It has a slightly higher degree of osmolarity (i.e. more solute per litre) than blood (hence, though it is said to be isotonic with blood in clinical contexts, this is a technical inaccuracy).

Note that in chemistry, a normal concentration of sodium chloride is 5.85% w/v (also expressed as 1M NaCl(aq)), which is 6.5 times more concentrated than medical NS.

Other

Other concentrations commonly used include

  1. Half-normal saline (0.45% NaCl), often with "D5" (5% dextrose), contains 77 mEq/L of Na and Cl and 50 g/L glucose.
  2. Quarter-normal saline (0.22% NaCl) has 39 mEq/L of Na and Cl and always contains 5% dextrose for osmolality reasons.
  3. Hypertonic saline is used in treating hyponatremia and cerebral edema. Due to hypertonicity, administration may result in phlebitis and tissue necrosis. As such, concentrations greater than 2% NaCl should only be administered via a central venous catheter. It is commonly available in two strengths:
    1. 3% NaCl has 513 mEq/L of Na and Cl.
    2. 5% NaCL has 856 mEq/L of Na and Cl.
  4. Dextrose (glucose) 4% in 0.18% saline is used sometimes for maintenance replacement.

Solutions of saline with added ingredients

In medicine, common types of salines include:

And in cell biology, in addition to the above the following are used:

Usage

The amount of normal saline infused depends largely on the needs of the patient (e.g. ongoing diarrhea or heart failure) but is typically between 1.5 and 3 litres a day for an adult.

Other concentrations of saline are frequently used for other medical purposes, such as supplying extra water to a dehydrated patient or supplying the daily water and salt needs ("maintenance" needs) of a patient who is unable to take them by mouth. Because infusing a solution of low osmolality can cause problems, intravenous solutions with reduced saline concentrations typically have dextrose (glucose) added to maintain a safe osmolality while providing less sodium chloride. As the molecular weight (MW) of dextrose is greater, this has the same osmolality as normal saline despite having less sodium. Because the dextrose used in these preparations is dextrose monohydrate (a commercial form having MW 198 in contrast to MW 180 for glucose), 5% dextrose is equivalent to 4.5% glucose.

History

Saline was believed to have originated during the cholera pandemic that swept across Europe in 1831. However, an examination of the composition of the fluids used by the pioneering physicians of that era reveals solutions that bear no resemblance to 0.9% or so-called 'normal' saline which appears to have very little scientific or historical basis for its routine use, except for Hamburger's in vitro studies of red cell lysis. It might be possible that the composition of 0.9% sodium chloride may not be 'normal' or physiologically accurate, as the current practice could be based on a historical fallacy or misconception.2

References

  1. ^ Prough, DS; Bidani, A (1999). "Hyperchloremic metabolic acidosis is a predictable consequence of intraoperative infusion of 0.9% saline". Anesthesiology 90: 1247-1249, http://www.anesthesiology.org/pt/re/anes/fulltext.00000542-199905000-00003.htm;jsessionid=L97P825yCKJn2HYBhbyhzynlZF1lTJQyHGR1JNK7nHTvscph2xfr!536197444!181195628!8091!-1. 
  2. ^ Awad, Sherif; Allison Simon P, Lobo Dileep N (April 2008). "The history of 0.9% saline". Clinical nutrition (Edinburgh, Scotland) 27 (2): 179–88. doi:10.1016/j.clnu.2008.01.008. PMID 18313809. 

See also
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